Healthcare Provider Details

I. General information

NPI: 1033083167
Provider Name (Legal Business Name): EMMA ELIZABETH ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 N FREEDOM BLVD
PROVO UT
84601-2824
US

IV. Provider business mailing address

491 N FREEDOM BLVD
PROVO UT
84601-2824
US

V. Phone/Fax

Practice location:
  • Phone: 801-960-2116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number129919343902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: