Healthcare Provider Details

I. General information

NPI: 1093633612
Provider Name (Legal Business Name): EMMA ELIZABETH PLUCINSKI ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4685 S HIGHLAND DR STE 224-C
SALT LAKE CITY UT
84117-5143
US

IV. Provider business mailing address

4685 S HIGHLAND DR STE 224-C
SALT LAKE CITY UT
84117-5143
US

V. Phone/Fax

Practice location:
  • Phone: 435-565-1782
  • Fax:
Mailing address:
  • Phone: 435-565-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14239659-6009
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14239659-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: