Healthcare Provider Details

I. General information

NPI: 1821444928
Provider Name (Legal Business Name): AMBERLEE ELLETT CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N STATE ST SUITE 3
SALINA UT
84654-1363
US

IV. Provider business mailing address

PO BOX 750362
TORREY UT
84775-0362
US

V. Phone/Fax

Practice location:
  • Phone: 435-691-0206
  • Fax:
Mailing address:
  • Phone: 435-691-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number341335-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: