Healthcare Provider Details

I. General information

NPI: 1407387798
Provider Name (Legal Business Name): LEONARD RENTFRO CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 W SOUTH JORDAN PKWY STE 202
SOUTH JORDAN UT
84095-4712
US

IV. Provider business mailing address

3854 S PANORAMA DR
SARATOGA SPRINGS UT
84045-3245
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-1155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5840053-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: