Healthcare Provider Details

I. General information

NPI: 1083230346
Provider Name (Legal Business Name): KAYLA ELLINGSON CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12569 S 2700 W
RIVERTON UT
84065-7182
US

IV. Provider business mailing address

12569 S 2700 W
RIVERTON UT
84065-7182
US

V. Phone/Fax

Practice location:
  • Phone: 801-209-9797
  • Fax: 801-206-3506
Mailing address:
  • Phone: 801-209-9797
  • Fax: 801-206-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12355694-6017
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12355694-6009
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12355694-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: