Healthcare Provider Details

I. General information

NPI: 1174272231
Provider Name (Legal Business Name): SASHA LOUTENSOCK CMHC INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 S LAKE ERIE DR STE B
WEST VALLEY UT
84120-7351
US

IV. Provider business mailing address

100 COTTAGE GATE LANE
ROSWELL GA
30076
US

V. Phone/Fax

Practice location:
  • Phone: 385-441-4900
  • Fax:
Mailing address:
  • Phone: 801-503-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016756
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13389638-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: