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NPI Code Detail

MEDICARE: CANYON COUNSELING CENTER, INC

MEDICARE: CANYON COUNSELING CENTER, INC
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
1103TC1900XCounseling Psychologist

General Provider Information

NPI Number : 1649946179
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANYON COUNSELING CENTER, INC
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 : OFFICE ASSISTANT
Name : KRISTIN PALMER
Credential :
Telephone Number : 801-372-3848
Provider Enumeration Date : 08/16/2021
Last Update Date : 08/16/2021

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Directions to “CANYON COUNSELING CENTER, INC ” Practice Location

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