MEDICARE: 180 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1760185144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	180 COUNSELING PLLC

Provider Business Mailing Address
First Line	:	3855 S 2520 W
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-4621
Country	:	US
Telephone Number	:	801-655-3442
Fax Number	:

Provider Business Practice Location Address
First Line	:	4455 S 700 E STE 201
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84107-3076
Country	:	US
Telephone Number	:	801-319-3666
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRANDON STEWART BUNKER
Credential	:	LCMHC
Telephone Number	:	801-655-3442

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/23/2023

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