Provider Demographics
NPI:1699018622
Name:COUNSELING CENTERS OF UTAH PLLC
Entity Type:Organization
Organization Name:COUNSELING CENTERS OF UTAH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERRIANN
Authorized Official - Middle Name:PARKS
Authorized Official - Last Name:BEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-558-7054
Mailing Address - Street 1:456 E BREWSTER DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5151
Mailing Address - Country:US
Mailing Address - Phone:801-558-7054
Mailing Address - Fax:
Practice Address - Street 1:9192 S 300 W STE 19
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2673
Practice Address - Country:US
Practice Address - Phone:801-558-7054
Practice Address - Fax:801-523-9239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT74078251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1041C0700XOtherCLINICAL SOCIAL WORK