Provider Demographics
NPI:1477946168
Name:ANGEL OAK FAMILY COUNSELING
Entity Type:Organization
Organization Name:ANGEL OAK FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABRISKIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-471-7080
Mailing Address - Street 1:1348 W STATE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-5021
Mailing Address - Country:US
Mailing Address - Phone:801-471-7080
Mailing Address - Fax:
Practice Address - Street 1:1348 W STATE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-5021
Practice Address - Country:US
Practice Address - Phone:801-471-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8001124-3902V251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health