Healthcare Provider Details

I. General information

NPI: 1467878116
Provider Name (Legal Business Name): LANAE KIMBER CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S 200 E STE 250
SALT LAKE CITY UT
84111-3846
US

IV. Provider business mailing address

660 S 200 E STE 250
SALT LAKE CITY UT
84111-3846
US

V. Phone/Fax

Practice location:
  • Phone: 801-920-6770
  • Fax:
Mailing address:
  • Phone: 801-920-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5819102-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: