Healthcare Provider Details

I. General information

NPI: 1679042303
Provider Name (Legal Business Name): CAROLYN MOTT HARVEY MFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 E 905 S
OREM UT
84058
US

IV. Provider business mailing address

1564 S 2050 E
SPANISH FORK UT
84660-8429
US

V. Phone/Fax

Practice location:
  • Phone: 801-931-9814
  • Fax:
Mailing address:
  • Phone: 858-349-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: