MEDICARE: WOODHAVEN AT MILLCREEK PSYCHOTHERAPY SERVICES

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1578207981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODHAVEN AT MILLCREEK PSYCHOTHERAPY SERVICES

Provider Business Mailing Address
First Line	:	1398 E LUCK LN
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84106-2944
Country	:	US
Telephone Number	:	801-712-1441
Fax Number	:

Provider Business Practice Location Address
First Line	:	1398 E LUCK LN
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84106-2944
Country	:	US
Telephone Number	:	801-712-1441
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHY WICKERSHAM
Credential	:	CMHC
Telephone Number	:	801-712-1441

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	04/21/2022

Similar Medicare Providers

1912156431 — KATHY WICKERSHAM
Practice Location Address:

1398 E LUCK LN
MILLCREEK, UT
84106-2944

Practice Phone: 801-251-6767
Practice Fax:

1033811401 — MILLCREEK THERAPY PSYCHOLOGICAL SERVICES
Practice Location Address:

1398 E LUCK LN
MILLCREEK, UT
84106-2944

Practice Phone: 801-870-3716
Practice Fax:

1700567799 — CORINNA FITZWATER CMHC
Practice Location Address:

1398 E LUCK LN
MILLCREEK, UT
84106-2944

Practice Phone: 801-251-6767
Practice Fax:

1093762221 — MILLCREEK HOME HEALTH
Practice Location Address:

1398 E LUCK LN
SALT LAKE CITY, UT
84106-2944

Practice Phone: 801-463-2478
Practice Fax: 801-486-0961

1558307793 — MILLCREEK HOME HEALTH
Practice Location Address:

1398 E LUCK LN
SALT LAKE CITY, UT
84106-2944

Practice Phone: 801-463-2478
Practice Fax: 801-486-0961

1396167110 — MILLCREEK HOME HEALTH, INC
Practice Location Address:

1398 E LUCK LN
SALT LAKE CITY, UT
84106-2944

Practice Phone: 801-463-2478
Practice Fax: 801-486-0961

Directions to “WOODHAVEN AT MILLCREEK PSYCHOTHERAPY SERVICES ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.