Healthcare Provider Details

I. General information

NPI: 1629415906
Provider Name (Legal Business Name): KERRI BURNS CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E 1200 S SUITE 104
OREM UT
84058-6972
US

IV. Provider business mailing address

313 E 1200 S SUITE 104
OREM UT
84058-6972
US

V. Phone/Fax

Practice location:
  • Phone: 801-377-1595
  • Fax: 801-768-4636
Mailing address:
  • Phone: 801-377-1595
  • Fax: 801-768-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number324491-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: