Healthcare Provider Details

I. General information

NPI: 1376451740
Provider Name (Legal Business Name): EMILY ANN SMITH ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10459 S TEMPLE DR STE 102
SOUTH JORDAN UT
84095-8930
US

IV. Provider business mailing address

783 W GREENOAKS DR
SALT LAKE CITY UT
84123-4903
US

V. Phone/Fax

Practice location:
  • Phone: 385-419-1373
  • Fax:
Mailing address:
  • Phone: 801-341-9448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7847469-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: