Provider Demographics
NPI:1508169632
Name:REALL, CARRIE JO (CMHC)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:JO
Last Name:REALL
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMHC
Mailing Address - Street 1:3375 W MAYFLOWER WAY STE A
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3135
Mailing Address - Country:US
Mailing Address - Phone:801-331-6775
Mailing Address - Fax:801-766-2010
Practice Address - Street 1:3375 W MAYFLOWER WAY STE A
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-331-6775
Practice Address - Fax:801-766-2010
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-11
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139247-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional