Healthcare Provider Details

I. General information

NPI: 1609455302
Provider Name (Legal Business Name): AFFILIATED COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E SHELLY LOUISE DR
SANDY UT
84070-4253
US

IV. Provider business mailing address

PO BOX 3264
SALT LAKE CITY UT
84110-3264
US

V. Phone/Fax

Practice location:
  • Phone: 801-685-2110
  • Fax: 801-685-9570
Mailing address:
  • Phone: 801-685-2110
  • Fax: 801-685-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE PAXTON
Title or Position: MANAGING PARTNER
Credential: LCSW
Phone: 801-685-2110