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General NPI Number Information
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NPI Number | 1891275020
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Entity Type | Organization
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Legal Business Name | BOE EBY CMHC, LLC
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 7105 S HIGHLAND DR STE 200
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-7311
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Country | US
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Telephone | 801-913-5346
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Fax |
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Provider Business Mailing Address
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Address Line | 7244 W FLAXTON LN
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City | WEST JORDAN
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State | UT
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Zip | 84081-5759
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Country | US
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Telephone | 801-913-5346
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | BOE EBY
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Credential | CMHC
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Telephone | 801-913-5346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 5069670-6004
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License Number State | UT
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