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General NPI Number Information
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NPI Number | 1497529630
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Entity Type | Organization
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Legal Business Name | MOUNTAINSIDE COUNSELING PLLC
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 240 N EAST PROMONTORY STE 200
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City | FARMINGTON
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State | UT
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Zip | 84025-2950
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Country | US
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Telephone | 385-390-3579
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Fax |
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Provider Business Mailing Address
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Address Line | 240 N EAST PROMONTORY STE 200
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City | FARMINGTON
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State | UT
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Zip | 84025-2950
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Country | US
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Telephone | 385-390-3579
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MRS. MCKENZIE MARIA ANDERSON
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Credential | LCSW
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Telephone | 385-390-3579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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