Healthcare Provider Details

I. General information

NPI: 1083524474
Provider Name (Legal Business Name): LESLIE PETERSON MYERS AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10718 S BECKSTEAD LN
SOUTH JORDAN UT
84095-2604
US

IV. Provider business mailing address

14748 SOUTH WHITE RIDGE COVE 14748 SOUTH WHITE RIDGE COVE
HERRIMAN UT
84096-1267
US

V. Phone/Fax

Practice location:
  • Phone: 801-477-0041
  • Fax:
Mailing address:
  • Phone: 801-783-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14299400-3903
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: