Provider Demographics
NPI:1366872368
Name:MOVITZ, DAVID (ACMHC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MOVITZ
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4523 S COUNTRYLANE RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4133
Mailing Address - Country:US
Mailing Address - Phone:801-558-9037
Mailing Address - Fax:
Practice Address - Street 1:4523 S COUNTRYLANE RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4133
Practice Address - Country:US
Practice Address - Phone:801-558-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8345564-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health