Healthcare Provider Details

I. General information

NPI: 1790266682
Provider Name (Legal Business Name): MOUNTAIN VIEW FAMILY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 W 12600 S
RIVERTON UT
84065-7119
US

IV. Provider business mailing address

3002 W 12600 S
RIVERTON UT
84065-7119
US

V. Phone/Fax

Practice location:
  • Phone: 801-930-0411
  • Fax: 801-931-2211
Mailing address:
  • Phone: 801-930-0411
  • Fax: 801-931-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TRACIE PENUNURI
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LCSW
Phone: 801-930-0411