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General NPI Number Information
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NPI Number | 1700139862
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Entity Type | Individual
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Provider Name | CHRISTINA DIETZ CMHC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12441 S 900 E # 170
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City | DRAPER
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State | UT
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Zip | 84020-9807
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Country | US
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Telephone | 801-683-1160
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Fax |
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Provider Business Mailing Address
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Address Line | 10246 S SAMUEL HOLT DR
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8840
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Country | US
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Telephone | 801-440-7177
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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 | 8020295-6004
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License Number State | UT
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