Provider Demographics
NPI:1851170385
Name:LUNT, KAITLYN FAY
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:FAY
Last Name:LUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 S JORDAN PKWY SUITE 237
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-6293
Mailing Address - Country:US
Mailing Address - Phone:801-871-5118
Mailing Address - Fax:
Practice Address - Street 1:489 W SOUTH JORDAN PKWY STE 237
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3979
Practice Address - Country:US
Practice Address - Phone:801-871-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty