Provider Demographics
NPI:1760730600
Name:SACRED HOOP HEALING CENTER
Entity Type:Organization
Organization Name:SACRED HOOP HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:GOSLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:435-868-1040
Mailing Address - Street 1:210 W 200 N
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2852
Mailing Address - Country:US
Mailing Address - Phone:801-400-8460
Mailing Address - Fax:
Practice Address - Street 1:210 W 200 N
Practice Address - Street 2:SUITE 106
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2852
Practice Address - Country:US
Practice Address - Phone:801-400-8460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT327723-6004101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty