Healthcare Provider Details

I. General information

NPI: 1629834353
Provider Name (Legal Business Name): HEALING HOUSE THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 E TREASURE MOUNTAIN CIR
SANDY UT
84093-1749
US

IV. Provider business mailing address

3556 S 5600 W STE 1
WEST VALLEY CITY UT
84120-2815
US

V. Phone/Fax

Practice location:
  • Phone: 881-477-0127
  • Fax:
Mailing address:
  • Phone: 801-477-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA KNUTH
Title or Position: THERAPIST, CO-FOUNDER, SUPERVISOR
Credential: CMHC
Phone: 801-499-4244