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General NPI Number Information
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NPI Number | 1477171866
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Entity Type | Individual
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Provider Name | MARTHA KATALIN WYLD LCMHC
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Gender | Female
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Dates
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Enumeration Date | 07/11/2020
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 7069 S HIGHLAND DR STE 115
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-3731
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Country | US
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Telephone | 801-231-0946
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Fax |
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Provider Business Mailing Address
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Address Line | 7069 S HIGHLAND DR STE 115
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-3731
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Country | US
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Telephone | 801-231-0946
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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 | 11829498-6004
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License Number State | UT
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