Provider Demographics
NPI:1891751616
Name:KANE, CHRISTY P (PHD, CMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:P
Last Name:KANE
Suffix:
Gender:F
Credentials:PHD, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9722 N 5650 W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3533
Mailing Address - Country:US
Mailing Address - Phone:801-735-5971
Mailing Address - Fax:801-748-2271
Practice Address - Street 1:5455 W 11000 N STE 204
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8802
Practice Address - Country:US
Practice Address - Phone:385-223-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5716781-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1891751616OtherNPI NUMBER