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General NPI Number Information
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NPI Number | 1730986696
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Entity Type | Organization
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Legal Business Name | CARBAJAL KIDS, LLC
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 5617 SOUTH 1475 EAST
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4572
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Country | US
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Telephone | 801-989-3488
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Fax |
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Provider Business Mailing Address
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Address Line | 5617 SOUTH 1475 EAST
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4572
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | STEPHANIE CARBAJAL
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Credential | LMFT, RPT-S
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Telephone | 801-989-3488
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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 |
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License Number State |
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