Healthcare Provider Details

I. General information

NPI: 1760893655
Provider Name (Legal Business Name): LAURA MOHLMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 E MYRTLE AVE STE 204
MURRAY UT
84107-4850
US

IV. Provider business mailing address

35 W CENTER ST UNIT 8110
MIDVALE UT
84047-6839
US

V. Phone/Fax

Practice location:
  • Phone: 801-369-8989
  • Fax:
Mailing address:
  • Phone: 801-885-8132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013133
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19650
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19683
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117526
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61503413
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7010360-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: