Healthcare Provider Details

I. General information

NPI: 1982901963
Provider Name (Legal Business Name): ALISON WATTS ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 S HIGHLAND DR STE 210
SALT LAKE CITY UT
84124-3550
US

IV. Provider business mailing address

345 E 4500 S STE 260
MURRAY UT
84107-3954
US

V. Phone/Fax

Practice location:
  • Phone: 888-949-4864
  • Fax:
Mailing address:
  • Phone: 801-747-3556
  • Fax: 801-747-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5201701-6009
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: