MEDICARE: KIND MINDS COUNSELING OF UTAH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1013750496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIND MINDS COUNSELING OF UTAH LLC

Provider Business Mailing Address
First Line	:	4676 S DEERCREEK RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-5606
Country	:	US
Telephone Number	:	281-825-6296
Fax Number	:

Provider Business Practice Location Address
First Line	:	9829 S 1300 E STE 301
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-4073
Country	:	US
Telephone Number	:	281-825-6296
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTY ORUM
Credential	:	MA, CMHC
Telephone Number	:	281-825-6296

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/14/2024

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