Healthcare Provider Details

I. General information

NPI: 1023414687
Provider Name (Legal Business Name): GOOD FRIENDS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

1450 E 820 N
OREM UT
84097-5481
US

V. Phone/Fax

Practice location:
  • Phone: 801-377-6685
  • Fax:
Mailing address:
  • Phone: 801-377-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number261856-3501
License Number StateUT

VIII. Authorized Official

Name: MR. BRIAN LEROY TAYLOR
Title or Position: PRESIDENT
Credential:
Phone: 801-830-3462