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General NPI Number Information
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NPI Number | 1285441337
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Entity Type | Individual
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Provider Name | EMMA LAURSEN CMHC INTERN
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Gender | Female
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 11260 S RIVER HEIGHTS DR
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-5119
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Country | US
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Telephone | 385-308-8403
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Fax |
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Provider Business Mailing Address
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Address Line | 4856 S HIGHLAND CIR APT 2
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City | HOLLADAY
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State | UT
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Zip | 84117-6040
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Country | US
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Telephone | 801-657-1760
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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