Healthcare Provider Details

I. General information

NPI: 1346103173
Provider Name (Legal Business Name): CLEAR CREEK COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 N 250 E 220291
CENTERFIELD UT
84622
US

IV. Provider business mailing address

260 N 250 E 220291
CENTERFIELD UT
84622
US

V. Phone/Fax

Practice location:
  • Phone: 385-955-0821
  • Fax:
Mailing address:
  • Phone: 385-955-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RYAN OLSEN
Title or Position: OWNER
Credential: LCSW
Phone: 801-513-6332