Healthcare Provider Details

I. General information

NPI: 1700710944
Provider Name (Legal Business Name): GOLDEN GROVE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 E 300 S
PROVO UT
84606-4934
US

IV. Provider business mailing address

885 E 300 S
PROVO UT
84606-4934
US

V. Phone/Fax

Practice location:
  • Phone: 702-820-6676
  • Fax:
Mailing address:
  • Phone: 702-820-6676
  • 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: KELLEY WHICKER
Title or Position: OWNER
Credential: LCSW
Phone: 702-820-6676