Provider Demographics
NPI:1073157251
Name:INNER PEACE COUNSELING OF UTAH
Entity Type:Organization
Organization Name:INNER PEACE COUNSELING OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:PAIX
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-202-5645
Mailing Address - Street 1:11618 S STATE ST STE 1604
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7123
Mailing Address - Country:US
Mailing Address - Phone:385-202-5645
Mailing Address - Fax:
Practice Address - Street 1:11618 S STATE ST STE 1604
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7123
Practice Address - Country:US
Practice Address - Phone:385-202-5645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty