Healthcare Provider Details
I. General information
NPI: 1942880075
Provider Name (Legal Business Name): WILLOW SHORE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/13/2021
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1220 N 500 W STE 201
LEHI UT
84043-1107
US
IV. Provider business mailing address
1220 N 500 W STE 201
LEHI UT
84043-1107
US
V. Phone/Fax
- Phone: 385-519-4585
- Fax:
- Phone: 801-382-8676
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 106H00000X |
| Taxonomy | Marriage & Family Therapist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
AISLINN
BURKE
Title or Position: OWNER
Credential: LMFT
Phone: 801-404-3225