Provider Demographics
NPI:1134465909
Name:HOPEFUL BEGINNINGS
Entity type:Organization
Organization Name:HOPEFUL BEGINNINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:NICKLES
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-979-1351
Mailing Address - Street 1:3536 S MASON VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-3505
Mailing Address - Country:US
Mailing Address - Phone:801-979-1351
Mailing Address - Fax:
Practice Address - Street 1:5667 S REDWOOD RD UNIT 6B
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5495
Practice Address - Country:US
Practice Address - Phone:801-979-1351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-22
Last Update Date:2012-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT304614-6004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health