Provider Demographics
NPI:1457068512
Name:MOUNTAIN VIEW COUNSELING OF NORTH OGDEN
Entity Type:Organization
Organization Name:MOUNTAIN VIEW COUNSELING OF NORTH OGDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CHILD-ILLUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-240-0310
Mailing Address - Street 1:805 E 3300 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1794
Mailing Address - Country:US
Mailing Address - Phone:385-240-0310
Mailing Address - Fax:
Practice Address - Street 1:805 E 3300 N
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-1794
Practice Address - Country:US
Practice Address - Phone:385-240-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty