Healthcare Provider Details

I. General information

NPI: 1083568778
Provider Name (Legal Business Name): FOUR SEASONS COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11492 S 3420 W
SOUTH JORDAN UT
84095-8159
US

IV. Provider business mailing address

11492 S 3420 W
SOUTH JORDAN UT
84095-8159
US

V. Phone/Fax

Practice location:
  • Phone: 360-951-0454
  • Fax:
Mailing address:
  • Phone: 360-951-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARY GARRETT
Title or Position: OWNER/THERAPIST
Credential: MA, ACMHC
Phone: 360-951-0454