Healthcare Provider Details

I. General information

NPI: 1225619737
Provider Name (Legal Business Name): MEADOWBROOK COUNSELING OF UTAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N 1200 W
OREM UT
84057-2449
US

IV. Provider business mailing address

1433 N 1200 W
OREM UT
84057-2449
US

V. Phone/Fax

Practice location:
  • Phone: 801-251-6442
  • Fax:
Mailing address:
  • Phone: 801-251-6442
  • 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: WHITNEY HEBBERT
Title or Position: MANAGER
Credential: LMFT
Phone: 805-231-4967