Healthcare Provider Details

I. General information

NPI: 1699220764
Provider Name (Legal Business Name): PURPLE SKY COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W 910 S STE 12
HEBER CITY UT
84032-2447
US

IV. Provider business mailing address

450 W 910 S STE 12
HEBER CITY UT
84032-2447
US

V. Phone/Fax

Practice location:
  • Phone: 435-709-3060
  • Fax: 435-709-3060
Mailing address:
  • Phone: 435-709-3060
  • Fax: 435-709-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASSIDY DUHADWAY
Title or Position: OWNER
Credential: LCSW
Phone: 435-709-3060