Healthcare Provider Details

I. General information

NPI: 1912872755
Provider Name (Legal Business Name): MESA COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 S ROWAN CV
WEST VALLEY CITY UT
84128-2414
US

IV. Provider business mailing address

3702 S ROWAN CV
WEST VALLEY CITY UT
84128-2414
US

V. Phone/Fax

Practice location:
  • Phone: 801-624-9885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUMIAYA MOHAMMAD
Title or Position: SOLE MBR/OWNER
Credential: CMHC
Phone: 801-624-9885