Provider Demographics
NPI:1134359896
Name:DESTINATION HOPE COUNSELING, LLC
Entity type:Organization
Organization Name:DESTINATION HOPE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:801-806-4226
Mailing Address - Street 1:1190 SPRING CREEK PL
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-3045
Mailing Address - Country:US
Mailing Address - Phone:801-806-4226
Mailing Address - Fax:801-806-4227
Practice Address - Street 1:1190 SPRING CREEK PL
Practice Address - Street 2:SUITE D-2
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-3045
Practice Address - Country:US
Practice Address - Phone:801-806-4226
Practice Address - Fax:801-806-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15464261QM0801X, 261QM0850X, 261QM0855X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health