Healthcare Provider Details

I. General information

NPI: 1073203204
Provider Name (Legal Business Name): TRAILS TO WELLNESS COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 S VINE ST UNIT 6
MURRAY UT
84107-7746
US

IV. Provider business mailing address

296 W 400 N
AMERICAN FORK UT
84003-1567
US

V. Phone/Fax

Practice location:
  • Phone: 435-669-3811
  • Fax:
Mailing address:
  • Phone: 435-669-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ADRIANNE ANNETTE DURRANT
Title or Position: OWNER
Credential: LCSW
Phone: 435-669-3811