Provider Demographics
NPI:1306273164
Name:EBY, BOE DANIEL (ACMHC)
Entity type:Individual
Prefix:
First Name:BOE
Middle Name:DANIEL
Last Name:EBY
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 1:7244 W FLAXTON LN
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5759
Mailing Address - Country:US
Mailing Address - Phone:801-913-5346
Mailing Address - Fax:
Practice Address - Street 1:7105 S HIGHLAND DR STE 200
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-7311
Practice Address - Country:US
Practice Address - Phone:801-913-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5069670-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health