Healthcare Provider Details

I. General information

NPI: 1750940896
Provider Name (Legal Business Name): GOLDEN STEPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N MAIN ST # 200
NORTH LOGAN UT
84341-5740
US

IV. Provider business mailing address

2600 N MAIN ST # 200
NORTH LOGAN UT
84341-5740
US

V. Phone/Fax

Practice location:
  • Phone: 435-774-6533
  • Fax:
Mailing address:
  • Phone: 435-774-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: COLDEN D GLENN
Title or Position: OWNER
Credential:
Phone: 435-774-6533