Provider Demographics
NPI:1194223867
Name:COTTONWOOD BEHAVIORAL COUNSELING LLC
Entity Type:Organization
Organization Name:COTTONWOOD BEHAVIORAL COUNSELING LLC
Other - Org Name:ABA SPECIALISTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:PERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-557-1154
Mailing Address - Street 1:6337 S HIGHLAND DR # 227
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2107
Mailing Address - Country:US
Mailing Address - Phone:385-313-9001
Mailing Address - Fax:
Practice Address - Street 1:6337 S HIGHLAND DR # 227 SUITE 227
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-8558
Practice Address - Country:US
Practice Address - Phone:385-313-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty