Provider Demographics
NPI:1477347441
Name:MOERK, HANNAH REBECCA (ACMHC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:REBECCA
Last Name:MOERK
Suffix:
Gender:
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 E MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2723
Mailing Address - Country:US
Mailing Address - Phone:385-645-9299
Mailing Address - Fax:
Practice Address - Street 1:138 E 12300 S # 193
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7976
Practice Address - Country:US
Practice Address - Phone:801-548-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14168159-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health