Provider Demographics
NPI:1053854166
Name:VELVET COUNSELING
Entity Type:Organization
Organization Name:VELVET COUNSELING
Other - Org Name:VELVET COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VELVET
Authorized Official - Middle Name:R
Authorized Official - Last Name:STAUB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-512-1463
Mailing Address - Street 1:123 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1509
Mailing Address - Country:US
Mailing Address - Phone:801-709-9089
Mailing Address - Fax:
Practice Address - Street 1:123 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1509
Practice Address - Country:US
Practice Address - Phone:801-709-9089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5125926-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000086423Medicare UPIN