Healthcare Provider Details

I. General information

NPI: 1194335471
Provider Name (Legal Business Name): CURTIS SANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S 700 E STE 2A
SALT LAKE CITY UT
84102-2855
US

IV. Provider business mailing address

515 S 700 E STE 2A
SALT LAKE CITY UT
84102-2855
US

V. Phone/Fax

Practice location:
  • Phone: 385-227-8653
  • Fax:
Mailing address:
  • Phone: 385-227-8653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3481112
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: