Provider Demographics
NPI:1699220764
Name:PURPLE SKY COUNSELING, PLLC
Entity Type:Organization
Organization Name:PURPLE SKY COUNSELING, PLLC
Other - Org Name:PEAK PERFORMANCE AND COUNSELING SERVICES, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUHADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-709-3060
Mailing Address - Street 1:450 W 910 S STE 12
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-2447
Mailing Address - Country:US
Mailing Address - Phone:435-709-3060
Mailing Address - Fax:435-709-3060
Practice Address - Street 1:450 W 910 S STE 12
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2447
Practice Address - Country:US
Practice Address - Phone:435-709-3060
Practice Address - Fax:435-709-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1558621433Medicaid