Basic Information
Provider Information
NPI: 1043838592
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEYER
FirstName: WENDY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CMHC, NCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5047 S GALLERIA DRIVE
Address2:  
City: MURRAY
State: UT
PostalCode: 84123
CountryCode: US
TelephoneNumber: 8014868143
FaxNumber: 8017466090
Practice Location
Address1: 9361 S 300 E
Address2:  
City: SANDY
State: UT
PostalCode: 840702902
CountryCode: US
TelephoneNumber: 8018265000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/10/2020
LastUpdateDate: 05/27/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/27/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400X  N Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
101Y00000X  N Behavioral Health & Social Service ProvidersCounselor 
101YP2500X  N Behavioral Health & Social Service ProvidersCounselorProfessional
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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