MEDICARE: CABAN COUNSELING 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1215587316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CABAN COUNSELING LLC

Provider Business Mailing Address
First Line	:	2789 W 9760 S
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-3249
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2789 W 9760 S
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-3249
Country	:	US
Telephone Number	:	801-856-5918
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KARLA ISBELL
Credential	:	LCSW
Telephone Number	:	801-856-4647

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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Directions to “CABAN COUNSELING LLC ” Practice Location

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