Healthcare Provider Details

I. General information

NPI: 1306705025
Provider Name (Legal Business Name): TERRI LYNN CONDIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 GRANT AVE
OGDEN UT
84401-2304
US

IV. Provider business mailing address

1138 AVALON HILLS DR
OGDEN UT
84404-6635
US

V. Phone/Fax

Practice location:
  • Phone: 801-429-9882
  • Fax:
Mailing address:
  • Phone: 801-429-9882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14239248-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: