Healthcare Provider Details

I. General information

NPI: 1881221828
Provider Name (Legal Business Name): MONICA ANN HULLINGER CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 S 600 E
PAYSON UT
84651-4561
US

IV. Provider business mailing address

4076 W 5600 S
SPANISH FORK UT
84660-4333
US

V. Phone/Fax

Practice location:
  • Phone: 801-864-0801
  • Fax:
Mailing address:
  • Phone: 801-362-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number313676-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: