Healthcare Provider Details

I. General information

NPI: 1679128599
Provider Name (Legal Business Name): FLOURISH THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 03/13/2024
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

1422 E 820 N
OREM UT
84097-5481
US

V. Phone/Fax

Practice location:
  • Phone: 385-309-1038
  • Fax:
Mailing address:
  • Phone: 385-309-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID PHILLIP SCOVILLE
Title or Position: DIRECTOR
Credential: MS
Phone: 801-709-1785