Provider Demographics
NPI:1295420503
Name:RIDGELINE COUNSELING
Entity type:Organization
Organization Name:RIDGELINE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENJI
Authorized Official - Middle Name:KIHARA
Authorized Official - Last Name:HAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-287-0795
Mailing Address - Street 1:6778 S 700 E
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1359
Mailing Address - Country:US
Mailing Address - Phone:541-287-0795
Mailing Address - Fax:
Practice Address - Street 1:6778 S 700 E
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1359
Practice Address - Country:US
Practice Address - Phone:541-287-0795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty