Healthcare Provider Details

I. General information

NPI: 1659760411
Provider Name (Legal Business Name): AFFINITY GUIDANCE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 N STATE ST
PROVO UT
84604-1012
US

IV. Provider business mailing address

1971 N STATE ST
PROVO UT
84604-1012
US

V. Phone/Fax

Practice location:
  • Phone: 855-200-2471
  • Fax: 435-578-0700
Mailing address:
  • Phone: 855-200-2471
  • Fax: 435-578-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10870
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10870
License Number StateUT

VIII. Authorized Official

Name: MR. BRADLEY JACKSON NEUFELD
Title or Position: PRESIDENT
Credential:
Phone: 855-200-2471