Healthcare Provider Details

I. General information

NPI: 1285045948
Provider Name (Legal Business Name): MONTE HAUCK ACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N OREM BLVD
OREM UT
84057-6601
US

IV. Provider business mailing address

PO BOX 51275
PROVO UT
84605-1275
US

V. Phone/Fax

Practice location:
  • Phone: 801-222-0603
  • Fax: 801-222-0218
Mailing address:
  • Phone: 435-462-9336
  • Fax: 435-462-5336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6521025-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: