Healthcare Provider Details

I. General information

NPI: 1154960458
Provider Name (Legal Business Name): MILLS SUPPORTIVE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E 100 N
SPANISH FORK UT
84660-1805
US

IV. Provider business mailing address

1197 E 540 N
SPANISH FORK UT
84660-8002
US

V. Phone/Fax

Practice location:
  • Phone: 385-448-0134
  • Fax:
Mailing address:
  • Phone: 801-921-2049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHERI MILLS
Title or Position: PARTNER
Credential: LCSW
Phone: 801-921-2049