Healthcare Provider Details

I. General information

NPI: 1649994104
Provider Name (Legal Business Name): COLLABORATIVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 W RANCH RD
FARMINGTON UT
84025-5029
US

IV. Provider business mailing address

2023 W RANCH RD
FARMINGTON UT
84025-5029
US

V. Phone/Fax

Practice location:
  • Phone: 801-997-9098
  • Fax: 801-997-8369
Mailing address:
  • Phone: 801-997-9098
  • Fax: 801-997-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE INAUEN
Title or Position: OWNER/COUNSELOR
Credential: CMHC
Phone: 801-997-9098