Healthcare Provider Details

I. General information

NPI: 1376313742
Provider Name (Legal Business Name): ROSE MOUNTAIN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W 520 N
OREM UT
84057-4696
US

IV. Provider business mailing address

205 W 520 N
OREM UT
84057-4696
US

V. Phone/Fax

Practice location:
  • Phone: 385-330-0161
  • Fax:
Mailing address:
  • Phone: 385-330-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KATHY SPENCER
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 385-330-0161