Provider Demographics
NPI:1225204159
Name:FITCH, MICHAEL JUSTIN (CMHC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUSTIN
Last Name:FITCH
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 N HILLFIELD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041
Mailing Address - Country:US
Mailing Address - Phone:801-525-4645
Mailing Address - Fax:801-779-7808
Practice Address - Street 1:2317 N HILLFIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-525-4645
Practice Address - Fax:801-779-7808
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5013238-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health