Healthcare Provider Details

I. General information

NPI: 1215540372
Provider Name (Legal Business Name): KIMBERLY S MILLETT MSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 S OREM BLVD STE 1
OREM UT
84058-5030
US

IV. Provider business mailing address

53 N 1200 E
LINDON UT
84042-2236
US

V. Phone/Fax

Practice location:
  • Phone: 801-802-8608
  • Fax:
Mailing address:
  • Phone: 801-380-1088
  • 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: