Healthcare Provider Details

I. General information

NPI: 1295429454
Provider Name (Legal Business Name): HOLLY ANN KEPAS ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 E 3900 S
SALT LAKE CITY UT
84107-1677
US

IV. Provider business mailing address

4890 S 4380 W
KEARNS UT
84118-4759
US

V. Phone/Fax

Practice location:
  • Phone: 801-341-9448
  • Fax:
Mailing address:
  • Phone: 801-836-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13434424-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: