Healthcare Provider Details

I. General information

NPI: 1942011507
Provider Name (Legal Business Name): BRETT D BAKER ACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W 800 N BLDG C
OREM UT
84057-3746
US

IV. Provider business mailing address

5455 W 11000 N STE 201
HIGHLAND UT
84003-8820
US

V. Phone/Fax

Practice location:
  • Phone: 801-449-0017
  • Fax:
Mailing address:
  • Phone: 801-449-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14199626-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: