Provider Demographics
NPI:1073063269
Name:KRUPA, EMILEE (LMFT, SUDC)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:
Last Name:KRUPA
Suffix:
Gender:F
Credentials:LMFT, SUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7699 N WEEPING CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13552 S 110 W STE 204
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2403
Practice Address - Country:US
Practice Address - Phone:801-432-0883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2023-09-19
Deactivation Date:2023-07-31
Deactivation Code:
Reactivation Date:2023-09-19
Provider Licenses
StateLicense IDTaxonomies
UT8390657-3902106H00000X
UT8390657-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)