Provider Demographics
NPI:1851277982
Name:MORTENSON, AUBREY
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:MORTENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2155 E FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-2656
Mailing Address - Country:US
Mailing Address - Phone:801-647-8825
Mailing Address - Fax:
Practice Address - Street 1:3305 N UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7429
Practice Address - Country:US
Practice Address - Phone:801-921-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist