Healthcare Provider Details

I. General information

NPI: 1417789967
Provider Name (Legal Business Name): INNER GROWTH COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 N HILL FIELD RD STE 122
LAYTON UT
84041-6958
US

IV. Provider business mailing address

397 S 1125 W
LAYTON UT
84041-5230
US

V. Phone/Fax

Practice location:
  • Phone: 801-663-1006
  • Fax:
Mailing address:
  • Phone: 801-663-1006
  • 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 Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MARCIA R LIGHT
Title or Position: OWNER
Credential: CMHC
Phone: 801-663-1006