Provider Demographics
NPI:1366211302
Name:DUSCH, MAKAYLA (EDS, LPCI)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:
Last Name:DUSCH
Suffix:
Gender:F
Credentials:EDS, LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 S IVY GABLE DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5068
Mailing Address - Country:US
Mailing Address - Phone:814-761-7041
Mailing Address - Fax:
Practice Address - Street 1:314 W BROADWAY STE 222
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2038
Practice Address - Country:US
Practice Address - Phone:814-761-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health