Provider Demographics
NPI:1487851978
Name:CRESCENT COUNSELING & CONSULTING,, LLC
Entity Type:Organization
Organization Name:CRESCENT COUNSELING & CONSULTING,, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE OWNER LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LASUDC
Authorized Official - Phone:385-235-6926
Mailing Address - Street 1:940 E. SOUTH UNION AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2302
Mailing Address - Country:US
Mailing Address - Phone:385-235-6926
Mailing Address - Fax:801-255-7284
Practice Address - Street 1:940 E. SOUTH UNION AVENUE
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2302
Practice Address - Country:US
Practice Address - Phone:385-235-6926
Practice Address - Fax:801-255-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT270969-6006101YA0400X
UT270969-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT788007788032Medicaid