Healthcare Provider Details

I. General information

NPI: 1609656636
Provider Name (Legal Business Name): ANDREW DUPUIS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 5600 S STE 200
MURRAY UT
84107-8150
US

IV. Provider business mailing address

151 E 5600 S STE 200
MURRAY UT
84107-8150
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-5418
  • Fax: 801-262-5468
Mailing address:
  • Phone: 801-262-5418
  • Fax: 801-262-5468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number13235333-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: