Provider Demographics
NPI:1124679600
Name:HUNSAKER, SHANALYN (LMFT)
Entity type:Individual
Prefix:
First Name:SHANALYN
Middle Name:
Last Name:HUNSAKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHANALYN
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATT CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:2850 N 2000 W STE 101
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9230
Practice Address - Country:US
Practice Address - Phone:801-528-5095
Practice Address - Fax:801-528-5094
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11475086-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT260022408OtherRAILRAOD MEDICARE
UT000055266OtherMEDICARE PIN
UT8760003008007Medicaid