Provider Demographics
NPI:1114373149
Name:FRISTRUP, NATALEE T (CMHC)
Entity Type:Individual
Prefix:
First Name:NATALEE
Middle Name:T
Last Name:FRISTRUP
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 OAK LN
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-7959
Mailing Address - Country:US
Mailing Address - Phone:385-865-9984
Mailing Address - Fax:888-786-5881
Practice Address - Street 1:124 S FAIRFIELD RD # A112
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-7105
Practice Address - Country:US
Practice Address - Phone:385-865-9984
Practice Address - Fax:888-786-5881
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103940846004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health