MEDICARE: TREE OF LIFE COUNSELING CENTER

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1437714797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREE OF LIFE COUNSELING CENTER

Provider Business Mailing Address
First Line	:	2727 N WASHINGTON BLVD STE 301
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-2276
Country	:	US
Telephone Number	:	801-710-0421
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 N WASHINGTON BLVD STE 301
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-2276
Country	:	US
Telephone Number	:	801-710-0421
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICHOLAS CALL
Credential	:	LCSW
Telephone Number	:	801-710-0421

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	05/02/2019

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