Healthcare Provider Details

I. General information

NPI: 1639028764
Provider Name (Legal Business Name): TANNER PASKETT ACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 S 1100 E
SALT LAKE CITY UT
84105-2441
US

IV. Provider business mailing address

2242 S 440 E BLDG F
SOUTH SALT LAKE UT
84115-2812
US

V. Phone/Fax

Practice location:
  • Phone: 385-645-8480
  • Fax:
Mailing address:
  • Phone: 801-644-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14265156
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: