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NPI Code Detail

MEDICARE: TANNER PASKETT ACMHC

MEDICARE: TANNER PASKETT ACMHC
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
1101YM0800XMental Health Counselor14265156UT

General Provider Information

NPI Number : 1639028764
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANNER PASKETT ACMHC
Provider Business Mailing Address
First Line : 2242 S 440 E BLDG F
Second Line :
City : SOUTH SALT LAKE
State : UT
Zip : 84115-2812
Country : US
Telephone Number : 801-644-5330
Fax Number :
Provider Business Practice Location Address
First Line : 1570 S 1100 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84105-2441
Country : US
Telephone Number : 385-645-8480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2026
Last Update Date : 01/22/2026

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Directions to “ TANNER PASKETT ACMHC” Practice Location

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