MEDICARE: FULL CIRCLE 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1972192631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL CIRCLE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	4640 S 3500 W STE 4
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-6522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4640 S 3500 W STE 4
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-6522
Country	:	US
Telephone Number	:	801-603-4792
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN HODGES
Credential	:
Telephone Number	:	801-603-4792

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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