Provider Demographics
NPI:1609642677
Name:SMITH, AMY LOUISE (CMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:SMITH
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:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-0982
Mailing Address - Country:US
Mailing Address - Phone:385-519-6784
Mailing Address - Fax:
Practice Address - Street 1:1325 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6090
Practice Address - Country:US
Practice Address - Phone:425-577-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12287888-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health