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General NPI Number Information
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NPI Number | 1821554049
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Entity Type | Organization
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Legal Business Name | MT GROVE COUNSELING LLC
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 66 E STATE RD
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2637
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Country | US
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Telephone | 801-404-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 66 E STATE RD
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2637
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Country | US
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Telephone | 801-404-0064
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | KATHERINE B BRUNER
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Credential | LCMHC
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Telephone | 801-636-3036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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