Provider Demographics
NPI:1740096619
Name:MORTENSEN, DENITA L (ACMHC)
Entity type:Individual
Prefix:
First Name:DENITA
Middle Name:L
Last Name:MORTENSEN
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5240
Mailing Address - Country:US
Mailing Address - Phone:801-494-4335
Mailing Address - Fax:
Practice Address - Street 1:1371 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-2204
Practice Address - Country:US
Practice Address - Phone:801-494-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141748846009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health