=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598821951
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTINE M. PLUMMER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1466 N HIGHWAY 89 STE 220
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84025-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-336-6363
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 741 S 800 E
-----------------------------------------------------
City | BOUNTIFUL
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84010-3827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-295-5566
-----------------------------------------------------
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 | 345512-3501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------