Healthcare Provider Details

I. General information

NPI: 1568750578
Provider Name (Legal Business Name): RICHARD CARLISLE TRIPP CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 10/12/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N STATE STREET
OREM UT
84057
US

IV. Provider business mailing address

309 N STATE STREET
OREM UT
84057
US

V. Phone/Fax

Practice location:
  • Phone: 801-369-4856
  • Fax: 801-434-8333
Mailing address:
  • Phone: 801-369-4856
  • Fax: 801-434-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7350051-6604
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7350051-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: