Provider Demographics
NPI:1447552740
Name:PEPPER, MARK MATTHEW (LCMHC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:MATTHEW
Last Name:PEPPER
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5827 S TWIN WILLOWS CIR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5777
Mailing Address - Country:US
Mailing Address - Phone:801-502-5751
Mailing Address - Fax:801-233-8748
Practice Address - Street 1:5827 S TWIN WILLOWS CIR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-5777
Practice Address - Country:US
Practice Address - Phone:801-502-5751
Practice Address - Fax:801-233-8748
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5416652-6009101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor