MEDICARE: BRINGING PEACE COUNSELING PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1679215347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRINGING PEACE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	5748 S 2200 W
Second Line	:
City	:	ROY
State	:	UT
Zip	:	84067-1502
Country	:	US
Telephone Number	:	801-628-1762
Fax Number	:	385-393-8181

Provider Business Practice Location Address
First Line	:	5974 FASHION POINT DR STE 240
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-4810
Country	:	US
Telephone Number	:	801-628-1762
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DENICE L PACHECO
Credential	:	LCSW
Telephone Number	:	801-628-1762

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	06/03/2022

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