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General NPI Number Information
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NPI Number | 1083258867
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Entity Type | Individual
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Provider Name | KIM REGINA WILLIAMS - REDMOND
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Gender | Female
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 1366 S LEGEND HILLS DR STE 130
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City | CLEARFIELD
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State | UT
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Zip | 84015-2373
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Country | US
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Telephone | 801-528-2718
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Fax |
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Provider Business Mailing Address
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Address Line | 1623 W 600 N
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City | CLINTON
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State | UT
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Zip | 84015-8470
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Country | US
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Telephone | 801-528-2718
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7811268-6604
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License Number State | UT
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