=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912618315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCW COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2022
-----------------------------------------------------
Last Update Date | 12/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 S MAIN ST STE 110
-----------------------------------------------------
City | CENTERVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84014-1846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-661-2794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3325 BOUNTIFUL BLVD
-----------------------------------------------------
City | BOUNTIFUL
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84010-4465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-797-4874
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, THERAPIST
-----------------------------------------------------
Name | DR. VICTORIA SCHILD BROWN
-----------------------------------------------------
Credential | DBH, LCSW
-----------------------------------------------------
Telephone | 801-661-2794
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------