Healthcare Provider Details

I. General information

NPI: 1619752227
Provider Name (Legal Business Name): CASCADE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 770 N
OREM UT
84097-4101
US

IV. Provider business mailing address

177 S 1050 W APT 20
PROVO UT
84601-7067
US

V. Phone/Fax

Practice location:
  • Phone: 385-208-7054
  • Fax:
Mailing address:
  • Phone: 385-208-7054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOEL WALLIS
Title or Position: OWNER
Credential: LCSW
Phone: 385-208-7054