Healthcare Provider Details

I. General information

NPI: 1164257655
Provider Name (Legal Business Name): DEEANNA CROASMUN ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S 200 E
SALT LAKE CITY UT
84111-3835
US

IV. Provider business mailing address

PO BOX 805
WENDOVER UT
84083-0805
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-2256
  • Fax:
Mailing address:
  • Phone: 435-830-4282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14241563-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: