Healthcare Provider Details

I. General information

NPI: 1508553991
Provider Name (Legal Business Name): CARRIE JOHNSON CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W 500 S STE 9
VERNAL UT
84078-2912
US

IV. Provider business mailing address

1140 W 500 S STE 9
VERNAL UT
84078-2912
US

V. Phone/Fax

Practice location:
  • Phone: 435-789-6300
  • Fax: 435-789-6357
Mailing address:
  • Phone: 435-789-6300
  • Fax: 435-789-6357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14031296-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: