Healthcare Provider Details

I. General information

NPI: 1265853089
Provider Name (Legal Business Name): DARREN JOHANSEN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W 400 N
OREM UT
84057-4663
US

IV. Provider business mailing address

310 W 400 N
OREM UT
84057-4663
US

V. Phone/Fax

Practice location:
  • Phone: 801-369-8702
  • Fax:
Mailing address:
  • Phone: 801-369-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5498400-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: