Healthcare Provider Details

I. General information

NPI: 1932657491
Provider Name (Legal Business Name): THE PHOENIX RECOVERY & COUNSELING CENTER - OREM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 W CENTER ST
OREM UT
84057-5201
US

IV. Provider business mailing address

11762 S STATE ST SUITE 360
DRAPER UT
84020-7155
US

V. Phone/Fax

Practice location:
  • Phone: 801-691-1761
  • Fax: 801-691-1759
Mailing address:
  • Phone: 801-571-6798
  • Fax: 801-619-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number30206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number30206
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number30206
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30206
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30206
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number30206
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number30206
License Number StateUT

VIII. Authorized Official

Name: MR. BRADLEY CHRISTENSEN
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 801-571-6798