Provider Demographics
NPI:1295147486
Name:RED WILLOW COUNSELING AND RECOVERY
Entity type:Organization
Organization Name:RED WILLOW COUNSELING AND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-556-6007
Mailing Address - Street 1:515 S 700 E STE 3D
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2801
Mailing Address - Country:US
Mailing Address - Phone:801-556-6007
Mailing Address - Fax:
Practice Address - Street 1:515 S 700 E STE 3D
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2801
Practice Address - Country:US
Practice Address - Phone:801-556-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health