=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023994449
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CANYON CREEK COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7533 S CENTER VIEW CT STE R
-----------------------------------------------------
City | WEST JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84084-5526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-477-6107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 S 500 E
-----------------------------------------------------
City | PAYSON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84651-2921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GROUP OWNER
-----------------------------------------------------
Name | JOSIE OSBORN
-----------------------------------------------------
Credential | LCMHC
-----------------------------------------------------
Telephone | 801-477-6107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------