Healthcare Provider Details

I. General information

NPI: 1588591994
Provider Name (Legal Business Name): NOVA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 W 100 N STE 202
PROVIDENCE UT
84332-9824
US

IV. Provider business mailing address

651 CANYON RD
LOGAN UT
84321-4240
US

V. Phone/Fax

Practice location:
  • Phone: 435-554-8077
  • Fax:
Mailing address:
  • Phone: 720-490-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HANNAH KATE Y SAWITSKY RISTORCELLI
Title or Position: OWNER, PRIMARY THERAPIST
Credential: CMHC
Phone: 720-490-1737