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NPI Code Detail

MEDICARE: ALLY COUNSELING, LLC

MEDICARE: ALLY 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 Worker8609120-3501UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11811347446OTHERUTPERSONAL

General Provider Information

NPI Number : 1700383502
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALLY COUNSELING, LLC
Provider Business Mailing Address
First Line : 1719 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-1911
Country : US
Telephone Number : 801-557-0958
Fax Number :
Provider Business Practice Location Address
First Line : 1719 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-1911
Country : US
Telephone Number : 801-557-0958
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CANDACE LEE CURZON
Credential : LCSW
Telephone Number : 801-557-0958
Provider Enumeration Date : 04/09/2018
Last Update Date : 04/09/2018

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Directions to “ALLY COUNSELING, LLC ” Practice Location

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