Healthcare Provider Details

I. General information

NPI: 1720699267
Provider Name (Legal Business Name): UTAH COMMUNITY COUNSELING AND BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 W CENTER ST # 302
OREM UT
84057-4605
US

IV. Provider business mailing address

1733 S 2940 E
SPANISH FORK UT
84660-8942
US

V. Phone/Fax

Practice location:
  • Phone: 801-918-6774
  • Fax:
Mailing address:
  • Phone: 801-918-6774
  • 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: DOUGLAS HUSTON
Title or Position: OWNER
Credential:
Phone: 801-918-6774