Healthcare Provider Details

I. General information

NPI: 1750917340
Provider Name (Legal Business Name): WHITE CANVAS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S STATE ST
OREM UT
84058-6354
US

IV. Provider business mailing address

212 E CROSSROADS BLVD # 107
SARATOGA SPRINGS UT
84045-2966
US

V. Phone/Fax

Practice location:
  • Phone: 435-820-0135
  • Fax:
Mailing address:
  • Phone: 435-820-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER SCOTT
Title or Position: OWNER
Credential: CMHC
Phone: 435-820-0135