Healthcare Provider Details

I. General information

NPI: 1447987078
Provider Name (Legal Business Name): APOLLO COUNSELING AND BEHAVIORAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 S FLEETWOOD DR
SALT LAKE CITY UT
84109-3215
US

IV. Provider business mailing address

3555 S FLEETWOOD DR
SALT LAKE CITY UT
84109-3215
US

V. Phone/Fax

Practice location:
  • Phone: 801-839-5193
  • Fax:
Mailing address:
  • Phone: 801-839-5193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREW G SAALFIELD
Title or Position: CO-OWNER, CONSULTANT
Credential: BCBA, LBA
Phone: 801-839-5193