Healthcare Provider Details

I. General information

NPI: 1992616874
Provider Name (Legal Business Name): GROVE CREST COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 N 1200 W
OREM UT
84057-2449
US

IV. Provider business mailing address

1636 W RIDGEWOOD LN
LINDON UT
84042-1881
US

V. Phone/Fax

Practice location:
  • Phone: 385-312-2231
  • Fax:
Mailing address:
  • Phone: 385-312-2231
  • 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: KATHY PETERSEN
Title or Position: OWNER
Credential: LCSW
Phone: 385-312-2231