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General NPI Number Information
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NPI Number | 1518293877
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Entity Type | Organization
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Legal Business Name | CC COUNSELING, LLC
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 337 NO. MAIN
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City | CEDAR CITY
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State | UT
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Zip | 84720
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Country | US
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Telephone | 435-559-4501
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2043
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City | CEDAR CITY
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State | UT
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Zip | 84721-2043
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Country | US
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Telephone | 435-559-4501
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA L REED
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Credential | L.C.S.W.
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Telephone | 435-559-4501
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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 | 60091783501
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License Number State | UT
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