Provider Demographics
NPI:1588850846
Name:MILESTONE COUNSELING SERVICES
Entity Type:Organization
Organization Name:MILESTONE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-782-6600
Mailing Address - Street 1:3149 N HWY 89 STE 303
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84404-1202
Mailing Address - Country:US
Mailing Address - Phone:801-782-6600
Mailing Address - Fax:801-782-6551
Practice Address - Street 1:3149 N HWY 89 STE 303
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-1202
Practice Address - Country:US
Practice Address - Phone:801-782-6600
Practice Address - Fax:801-782-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT352006-3902251S00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT788007788945Medicaid