Healthcare Provider Details

I. General information

NPI: 1487445953
Provider Name (Legal Business Name): ALIZA LUCILLE OPFAR ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALIZA LUCILLE OPFAR PEREZ ACMHC

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 S STATE ST STE 201
OREM UT
84097-8239
US

IV. Provider business mailing address

1826 N 400 W
OREM UT
84057-2140
US

V. Phone/Fax

Practice location:
  • Phone: 801-600-0308
  • Fax:
Mailing address:
  • Phone: 469-534-6188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14222278-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: