Individual
CAMI EMAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACMHC
Contact information
Practice address
750 N FREEDOM BLVD STE 300, PROVO, UT 84601-1690
(801) 373-4760
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
8367119-6006
UT
101YP2500X
Professional Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/09/2016
Last updated
01/29/2025
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