=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114889516
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. IELI CHARLIE TAUTUAA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2025
-----------------------------------------------------
Last Update Date | 01/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 403 W 820 N
-----------------------------------------------------
City | LEHI
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84043-1557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-570-7075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 403 W 820 N
-----------------------------------------------------
City | LEHI
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84043-1557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-570-7075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 9177050-2702
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------