MEDICARE: CORINNA FITZWATER 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	11291192-6004	UT

General Provider Information

NPI Number	:	1700567799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNA FITZWATER CMHC

Provider Business Mailing Address
First Line	:	4659 S QUAIL VISTA LN APT K
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4864
Country	:	US
Telephone Number	:	801-971-4866
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	:	801-251-6767
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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