Healthcare Provider Details

I. General information

NPI: 1922476167
Provider Name (Legal Business Name): RAIGAN C STEELE LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5288 S COMMERCE DR STE B258
MURRAY UT
84107-4309
US

IV. Provider business mailing address

5288 S COMMERCE DR STE B258
MURRAY UT
84107-4309
US

V. Phone/Fax

Practice location:
  • Phone: 801-917-9517
  • Fax:
Mailing address:
  • Phone: 801-917-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number374953-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: