MEDICARE: MICHAEL JUSTIN FITCH CMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5013238-6004	UT
2	101YM0800X	Mental Health Counselor	LCPC-8164	ID

General Provider Information

NPI Number	:	1225204159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JUSTIN FITCH CMHC

Provider Business Mailing Address
First Line	:	555 N FAIRFIELD RD
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-3339
Country	:	US
Telephone Number	:	801-660-0638
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 N FAIRFIELD RD
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-3339
Country	:	US
Telephone Number	:	801-660-0638
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	02/04/2026

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