Healthcare Provider Details

I. General information

NPI: 1396544763
Provider Name (Legal Business Name): ALEXIS IZATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 5600 S STE 200
SALT LAKE CITY UT
84107-8158
US

IV. Provider business mailing address

16255 VENTURA BLVD STE 830
ENCINO CA
91436-2317
US

V. Phone/Fax

Practice location:
  • Phone: 385-346-0031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14240290-6009
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number25-542
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: