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NPI Code Detail

MEDICARE: PALISADES COUNSELING LLC

MEDICARE: PALISADES 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
11041C0700XClinical Social Worker
2103TC1900XCounseling Psychologist

General Provider Information

NPI Number : 1225817414
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALISADES COUNSELING LLC
Provider Business Mailing Address
First Line : 3319 N UNIVERSITY AVE STE 100
Second Line :
City : PROVO
State : UT
Zip : 84604-4447
Country : US
Telephone Number : 801-356-0014
Fax Number :
Provider Business Practice Location Address
First Line : 3319 N UNIVERSITY AVE STE 100
Second Line :
City : PROVO
State : UT
Zip : 84604-4447
Country : US
Telephone Number : 801-356-0014
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SHAWN EDGINGTON
Credential : PHD
Telephone Number : 801-356-0014
Provider Enumeration Date : 09/26/2023
Last Update Date : 09/26/2023

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Directions to “PALISADES COUNSELING LLC ” Practice Location

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