Healthcare Provider Details

I. General information

NPI: 1366372765
Provider Name (Legal Business Name): AUDACITY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N UNIVERSITY AVE STE 208
PROVO UT
84601-3101
US

IV. Provider business mailing address

455 N UNIVERSITY AVE STE 208
PROVO UT
84601-3101
US

V. Phone/Fax

Practice location:
  • Phone: 720-357-9911
  • Fax:
Mailing address:
  • Phone: 720-357-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ARIEL JOY WOOTAN MERKLING
Title or Position: OWNER
Credential: LCSW
Phone: 720-357-9911