Healthcare Provider Details

I. General information

NPI: 1629677364
Provider Name (Legal Business Name): RIVER OAK COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 S 700 E STE 22
MURRAY UT
84107-2589
US

IV. Provider business mailing address

1368 W GREEN HEDGE WAY
WEST JORDAN UT
84084-4140
US

V. Phone/Fax

Practice location:
  • Phone: 801-833-1291
  • Fax:
Mailing address:
  • Phone:
  • 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: DIANA BALLARD
Title or Position: OWNER
Credential: LCSW
Phone: 801-833-1291