Healthcare Provider Details

I. General information

NPI: 1003720871
Provider Name (Legal Business Name): ADABELLE BALATICO CARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 S 2500 E
SPRINGVILLE UT
84663-3932
US

IV. Provider business mailing address

1140 S 2500 E
SPRINGVILLE UT
84663-3932
US

V. Phone/Fax

Practice location:
  • Phone: 801-602-1651
  • Fax:
Mailing address:
  • Phone: 801-602-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: