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General NPI Number Information
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NPI Number | 1720407398
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Entity Type | Individual
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Provider Name | CRYSTAL JEAN APPLEGATE CMHC
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Gender | Female
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 1196 W SOUTH JORDAN PKWY STE D
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-4603
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Country | US
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Telephone | 801-702-0427
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Fax |
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Provider Business Mailing Address
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Address Line | 11251 S STATE ST APT A207
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City | SANDY
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State | UT
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Zip | 84070-5163
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Country | US
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Telephone | 801-702-0427
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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 | 9838225-6004
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License Number State | UT
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