Healthcare Provider Details

I. General information

NPI: 1508400540
Provider Name (Legal Business Name): AMBERLI GEVERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2019
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 W SOUTH JORDAN PKWY STE B
SOUTH JORDAN UT
84095-5505
US

IV. Provider business mailing address

727 W 10 N
LINDON UT
84042-1747
US

V. Phone/Fax

Practice location:
  • Phone: 385-215-9084
  • Fax:
Mailing address:
  • Phone: 805-587-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: