Healthcare Provider Details

I. General information

NPI: 1124653530
Provider Name (Legal Business Name): MELISSA SHERMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 E 840 S
OREM UT
84058-5016
US

IV. Provider business mailing address

299 N 200 W
BOUNTIFUL UT
84010-7043
US

V. Phone/Fax

Practice location:
  • Phone: 801-226-7696
  • Fax: 801-225-7053
Mailing address:
  • Phone: 801-815-3443
  • Fax: 801-683-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7071348
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: