Healthcare Provider Details

I. General information

NPI: 1093568396
Provider Name (Legal Business Name): ANGELA BAIRD CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W UNIVERSITY PKWY
OREM UT
84058-6703
US

IV. Provider business mailing address

672 E PERRY HOLLOW DR
MAPLETON UT
84664-5576
US

V. Phone/Fax

Practice location:
  • Phone: 801-863-4780
  • Fax:
Mailing address:
  • Phone: 801-634-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: