Healthcare Provider Details

I. General information

NPI: 1518584994
Provider Name (Legal Business Name): STEPHEN SOMMERS CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 S OREM BLVD
OREM UT
84058-5011
US

IV. Provider business mailing address

742 W 1600 N
OREM UT
84057-2518
US

V. Phone/Fax

Practice location:
  • Phone: 801-903-5903
  • Fax:
Mailing address:
  • Phone: 801-616-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5835752-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: