Healthcare Provider Details

I. General information

NPI: 1215418959
Provider Name (Legal Business Name): COURAGE REINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 W 10400 N
HIGHLAND UT
84003-9569
US

IV. Provider business mailing address

5870 W 10400 N
HIGHLAND UT
84003-9569
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-8900
  • Fax:
Mailing address:
  • Phone: 801-756-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6573731-6006
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number426620
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6573731-3501
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KATIE CELAYA
Title or Position: DIRECTOR OF MENTAL HEALTH
Credential: MS
Phone: 801-362-3585