Healthcare Provider Details

I. General information

NPI: 1467240184
Provider Name (Legal Business Name): KIMBERLY GISHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 N 850 W
OREM UT
84057-4544
US

IV. Provider business mailing address

87 N 850 W
OREM UT
84057-4544
US

V. Phone/Fax

Practice location:
  • Phone: 801-360-5630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11446394-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: