Healthcare Provider Details

I. General information

NPI: 1871186593
Provider Name (Legal Business Name): PAPILLON HEALING SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W 540 N
OREM UT
84057-6631
US

IV. Provider business mailing address

236 W 540 N
OREM UT
84057-6631
US

V. Phone/Fax

Practice location:
  • Phone: 801-899-3610
  • Fax:
Mailing address:
  • Phone: 801-899-3610
  • 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: SOPHIE CROMAR
Title or Position: DIRECTOR OF MANAGEMENT
Credential:
Phone: 801-473-7923