Provider Demographics
NPI:1790422319
Name:THE COUNSELING CENTER FOR CHILDREN
Entity Type:Organization
Organization Name:THE COUNSELING CENTER FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STAR
Authorized Official - Middle Name:
Authorized Official - Last Name:POE ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-912-0987
Mailing Address - Street 1:4192 W MCKELLEN DR UNIT B2
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-2202
Mailing Address - Country:US
Mailing Address - Phone:336-423-7697
Mailing Address - Fax:
Practice Address - Street 1:12884 S FRONTRUNNER BLVD STE 140
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5488
Practice Address - Country:US
Practice Address - Phone:336-423-7697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)