Healthcare Provider Details

I. General information

NPI: 1760185144
Provider Name (Legal Business Name): 180 COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 S 700 E STE 201
MILLCREEK UT
84107-3076
US

IV. Provider business mailing address

3855 S 2520 W
WEST VALLEY CITY UT
84119-4621
US

V. Phone/Fax

Practice location:
  • Phone: 801-319-3666
  • Fax:
Mailing address:
  • Phone: 801-655-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRANDON STEWART BUNKER
Title or Position: OWNER
Credential: LCMHC
Phone: 801-655-3442