Provider Demographics
NPI:1275136228
Name:TOOELE VALLEY COUNSELING PLLC
Entity Type:Organization
Organization Name:TOOELE VALLEY COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARCI
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHW
Authorized Official - Phone:435-850-7378
Mailing Address - Street 1:28 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2139
Mailing Address - Country:US
Mailing Address - Phone:435-850-7378
Mailing Address - Fax:
Practice Address - Street 1:1244 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-5009
Practice Address - Country:US
Practice Address - Phone:435-850-7378
Practice Address - Fax:435-200-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1134559388Medicaid
NY1629357132Medicaid
UT1295027001Medicaid