Provider Demographics
NPI:1932457611
Name:NEWMAN, MISTY JUNE (CMHC)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:JUNE
Last Name:NEWMAN
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 1:10393 S TEMPLE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8883
Mailing Address - Country:US
Mailing Address - Phone:801-236-3892
Mailing Address - Fax:801-236-3890
Practice Address - Street 1:10393 S TEMPLE DR STE 103
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8883
Practice Address - Country:US
Practice Address - Phone:801-236-3892
Practice Address - Fax:801-236-3890
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8667946-6004101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty