Healthcare Provider Details

I. General information

NPI: 1265247704
Provider Name (Legal Business Name): RESILIENT ROOTS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E DRAPER PKWY STE 103
DRAPER UT
84020-9077
US

IV. Provider business mailing address

1111 E DRAPER PKWY STE 103
DRAPER UT
84020-9077
US

V. Phone/Fax

Practice location:
  • Phone: 801-829-1508
  • Fax:
Mailing address:
  • Phone: 801-829-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA LUDLOW HOLFELTZ
Title or Position: OWNER/CLINICAL DIRECTOR/COUNSELOR
Credential: CMHC, LPC-MHSP
Phone: 801-915-3882