Healthcare Provider Details

I. General information

NPI: 1548918584
Provider Name (Legal Business Name): DAVID MCLAUGHLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

10557 S SAGE CREEK RD
SOUTH JORDAN UT
84009-3972
US

V. Phone/Fax

Practice location:
  • Phone: 385-309-1038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12312457-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: