Healthcare Provider Details

I. General information

NPI: 1265085146
Provider Name (Legal Business Name): ZACKARY BUTTERFIELD CMHC, MED, EDS, BCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4933 S 1500 W STE 200
RIVERDALE UT
84405-7738
US

IV. Provider business mailing address

4933 S 1500 W STE 200
RIVERDALE UT
84405-7738
US

V. Phone/Fax

Practice location:
  • Phone: 385-330-2818
  • Fax: 385-405-7906
Mailing address:
  • Phone: 385-330-2818
  • Fax: 385-405-7906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10377393-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: