Healthcare Provider Details

I. General information

NPI: 1699611194
Provider Name (Legal Business Name): DESTYNI UPTON CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 N VERNAL AVE STE 1
VERNAL UT
84078-2100
US

IV. Provider business mailing address

210 E 600 S UNIT 5301
VERNAL UT
84078-3388
US

V. Phone/Fax

Practice location:
  • Phone: 435-200-5685
  • Fax:
Mailing address:
  • Phone: 495-790-4238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14223145-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: