Healthcare Provider Details

I. General information

NPI: 1356206999
Provider Name (Legal Business Name): MINDSCAPE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 N 400 E STE 101 STE 101
NORTH SALT LAKE UT
84054-1984
US

IV. Provider business mailing address

PO BOX 540611
NORTH SALT LAKE UT
84054-0611
US

V. Phone/Fax

Practice location:
  • Phone: 385-402-3396
  • Fax:
Mailing address:
  • Phone: 385-402-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY VANESSA ROSE
Title or Position: OWNER
Credential: LCSW
Phone: 801-610-1010