Healthcare Provider Details

I. General information

NPI: 1114818747
Provider Name (Legal Business Name): BROOKE WITTMAN CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE C WITTMAN

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10434 S 1055 W STE 201
SOUTH JORDAN UT
84095-1522
US

IV. Provider business mailing address

1433 N 1200 W
OREM UT
84057-2449
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5450
  • Fax: 385-225-9327
Mailing address:
  • Phone: 801-655-5450
  • Fax: 385-225-9327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13408610-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: