Individual
KAITLIN LONGFELLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMHC
Contact information
Practice address
2655 S LAKE ERIE DR, WEST VALLEY, UT 84120-7350
(385) 441-4900
Mailing address
2655 S LAKE ERIE DR, WEST VALLEY, UT 84120-7350
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
11758474-6004
UT
101YM0800X
Mental Health Counselor
11758474-6009
UT
Other
Enumeration date
06/05/2020
Last updated
12/05/2022
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