Healthcare Provider Details

I. General information

NPI: 1063104461
Provider Name (Legal Business Name): BEAR CREEK RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

1486 E 880 N
OREM UT
84097-5413
US

V. Phone/Fax

Practice location:
  • Phone: 385-399-0888
  • Fax: 385-375-6087
Mailing address:
  • Phone: 801-900-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MAKIN
Title or Position: OWNER
Credential: LCMHC
Phone: 801-900-1353