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General NPI Number Information
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NPI Number | 1285246652
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Entity Type | Individual
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Provider Name | WILL BRADON JOHN GROVE CMHC, LPC
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Gender | Male
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 10434 S 1055 W STE 101
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-1521
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Country | US
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Telephone | 801-355-2846
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Fax |
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Provider Business Mailing Address
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Address Line | 447 W BEARCAT DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-2519
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Country | US
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Telephone | 801-355-2846
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C8327
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 12307961-6004
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License Number State | UT
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