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General NPI Number Information
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NPI Number | 1497113831
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Entity Type | Individual
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Provider Name | TRACI LYN HATCH
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Gender | Female
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Dates
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Enumeration Date | 01/30/2016
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Last Update Date | 01/30/2016
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Provider Practice Location Address
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Address Line | 11576 S STATE ST 1001
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City | DRAPER
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State | UT
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Zip | 84020-6431
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Country | US
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Telephone | 801-550-3665
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Fax |
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Provider Business Mailing Address
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Address Line | 6903 S STARFLOWER WAY
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City | WEST JORDAN
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State | UT
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Zip | 84081-5228
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Country | US
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Telephone | 801-550-3665
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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 | 96612116009
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License Number State | UT
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