MEDICARE: ARENA 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
1	101YM0800X	Mental Health Counselor	6213475-6004	UT

General Provider Information

NPI Number	:	1912485889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARENA COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2670 S 2000 E STE 209
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1783
Country	:	US
Telephone Number	:	801-633-6933
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 S 2000 E STE 209
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1783
Country	:	US
Telephone Number	:	801-633-6933
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CLINICAL DIRECTOR
Name	:	MRS. LENNIE NICHOLS KNOWLTON
Credential	:	CMHC
Telephone Number	:	801-633-6933

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	10/19/2018

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