Healthcare Provider Details

I. General information

NPI: 1760104798
Provider Name (Legal Business Name): SPRINGVILLE FAMILY COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 N MAIN ST STE 11
SPRINGVILLE UT
84663-4016
US

IV. Provider business mailing address

1220 N MAIN ST STE 11
SPRINGVILLE UT
84663-4016
US

V. Phone/Fax

Practice location:
  • Phone: 801-400-5034
  • Fax: 801-373-4451
Mailing address:
  • Phone: 801-400-5034
  • Fax: 801-373-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRENT R. HALL
Title or Position: DIRECTOR
Credential: LMFT
Phone: 801-400-5034