Provider Demographics
NPI:1609455302
Name:AFFILIATED COUNSELING, LLC
Entity Type:Organization
Organization Name:AFFILIATED COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-685-2110
Mailing Address - Street 1:PO BOX 3264
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3264
Mailing Address - Country:US
Mailing Address - Phone:801-685-2110
Mailing Address - Fax:801-685-9570
Practice Address - Street 1:245 E SHELLY LOUISE DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4253
Practice Address - Country:US
Practice Address - Phone:801-685-2110
Practice Address - Fax:801-685-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health