Healthcare Provider Details

I. General information

NPI: 1366720104
Provider Name (Legal Business Name): DESERET COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SOUTH 800 EAST SUITE 115 ROOM 115 B
OREM UT
84097
US

IV. Provider business mailing address

1325 S 800 E SUITE 115 ROOM 115B
OREM UT
84097
US

V. Phone/Fax

Practice location:
  • Phone: 801-360-3166
  • Fax:
Mailing address:
  • Phone: 801-360-3166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JAMES MICHAEL NOORLANDER JR.
Title or Position: SOCIAL WORKER
Credential: MSW, CSW
Phone: 801-360-3166