Healthcare Provider Details

I. General information

NPI: 1467115857
Provider Name (Legal Business Name): KAIVARA COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 E 800 N
OREM UT
84097-4146
US

IV. Provider business mailing address

511 AARON AVE
SPRINGVILLE UT
84663-1543
US

V. Phone/Fax

Practice location:
  • Phone: 801-830-4499
  • Fax:
Mailing address:
  • Phone: 385-323-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
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: MS. AYMEE CONDIE
Title or Position: OWNER
Credential: LCSW
Phone: 801-830-4499