Provider Demographics
NPI:1184918849
Name:BLUE SANDS COUNSELING, LLC
Entity type:Organization
Organization Name:BLUE SANDS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-513-6866
Mailing Address - Street 1:2363 N HILL FIELD RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6909
Mailing Address - Country:US
Mailing Address - Phone:801-513-6866
Mailing Address - Fax:801-728-4516
Practice Address - Street 1:2363 N HILL FIELD RD
Practice Address - Street 2:SUITE 5
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-6909
Practice Address - Country:US
Practice Address - Phone:801-513-6866
Practice Address - Fax:801-728-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48971473501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health