Healthcare Provider Details

I. General information

NPI: 1881910586
Provider Name (Legal Business Name): AMANDA PEDEN CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 S OREM BLVD SUITE B
OREM UT
84058-5011
US

IV. Provider business mailing address

907 S OREM BLVD SUITE B
OREM UT
84058-5011
US

V. Phone/Fax

Practice location:
  • Phone: 801-400-4739
  • Fax:
Mailing address:
  • Phone: 801-400-4739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7827250-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: