Healthcare Provider Details

I. General information

NPI: 1023590932
Provider Name (Legal Business Name): BEAN COUNSELING & RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11075 S STATE ST STE 14
SANDY UT
84070-5194
US

IV. Provider business mailing address

11075 S STATE ST STE 16
SANDY UT
84070-5196
US

V. Phone/Fax

Practice location:
  • Phone: 385-539-4031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8949648-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1013215599
Identifier TypeOTHER
Identifier State
Identifier IssuerTYPE 1 NPI - INDIVIDUAL
# 2
Identifier1023590932
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerTYPE 2 NPI- GROUP

VIII. Authorized Official

Name: DALLAS BEAN
Title or Position: OWNER/THERAPIST
Credential:
Phone: 385-539-4031