Provider Demographics
NPI:1720699267
Name:UTAH COMMUNITY COUNSELING AND BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:UTAH COMMUNITY COUNSELING AND BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-918-6774
Mailing Address - Street 1:1733 S 2940 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-8942
Mailing Address - Country:US
Mailing Address - Phone:801-918-6774
Mailing Address - Fax:
Practice Address - Street 1:51 W CENTER ST # 302
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4605
Practice Address - Country:US
Practice Address - Phone:801-918-6774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty