Healthcare Provider Details

I. General information

NPI: 1508567991
Provider Name (Legal Business Name): IAN THOMAS MACGREGOR ACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S GENEVA RD
OREM UT
84059-5803
US

IV. Provider business mailing address

600 S GENEVA RD
OREM UT
84059-5803
US

V. Phone/Fax

Practice location:
  • Phone: 801-877-5300
  • Fax:
Mailing address:
  • Phone: 801-877-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12859755-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: