Provider Demographics
NPI:1033849633
Name:LEBRECHT, MERRITT GRACE (ACMHC, TRS, CTRS)
Entity Type:Individual
Prefix:
First Name:MERRITT
Middle Name:GRACE
Last Name:LEBRECHT
Suffix:
Gender:F
Credentials:ACMHC, TRS, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13417 S AINTREE AVE
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18406 W WHITE QUEST DR
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84013-9701
Practice Address - Country:US
Practice Address - Phone:801-335-4699
Practice Address - Fax:801-335-7031
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12103709-4002225800000X
UT12103709-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist