Healthcare Provider Details

I. General information

NPI: 1811848708
Provider Name (Legal Business Name): GREEN SAGE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 S 700 E STE 12-E
SALT LAKE CITY UT
84105-2149
US

IV. Provider business mailing address

669 E MILTON AVE
SALT LAKE CITY UT
84105-2112
US

V. Phone/Fax

Practice location:
  • Phone: 801-556-1611
  • Fax: 801-953-0982
Mailing address:
  • Phone: 801-556-1611
  • Fax: 801-953-0982

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: MS. VALERIE LEAVITT
Title or Position: PRESIDENT
Credential: LCSW
Phone: 801-556-1611