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General NPI Number Information
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NPI Number | 1306240916
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Entity Type | Organization
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Legal Business Name | ADOLESCENCE TO ADULTHOOD COUNSELING LLC
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 640 N MAIN ST STE 1474
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-2146
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Country | US
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Telephone | 801-891-0400
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Fax | 801-298-0846
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Provider Business Mailing Address
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Address Line | PO BOX 540724
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-0724
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Country | US
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Telephone | 801-891-0400
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Fax | 801-298-0846
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. KENNETH L HULL
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Credential | CMHC
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Telephone | 801-891-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 16382
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License Number State | UT
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