Provider Demographics
NPI:1417205634
Name:FASS, AIMEE E (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:E
Last Name:FASS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 HERITAGE PARK BLVD STE 200H
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5645
Mailing Address - Country:US
Mailing Address - Phone:385-393-4804
Mailing Address - Fax:
Practice Address - Street 1:920 HERITAGE PARK BLVD STE 200H
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5645
Practice Address - Country:US
Practice Address - Phone:385-393-4804
Practice Address - Fax:801-217-8162
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7775888-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000308007Medicaid
UT260022408OtherRAILROAD MEDICARE
UT876000308007Medicaid