Provider Demographics
NPI:1740508993
Name:ADOLESCENCE TO ADULTHOOD COUNSELING
Entity type:Organization
Organization Name:ADOLESCENCE TO ADULTHOOD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QWNER / CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:801-891-0400
Mailing Address - Street 1:PO BOX 540724
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-0724
Mailing Address - Country:US
Mailing Address - Phone:801-791-0400
Mailing Address - Fax:801-298-0846
Practice Address - Street 1:640 N MAIN ST
Practice Address - Street 2:SUITE 1474
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2162
Practice Address - Country:US
Practice Address - Phone:801-891-0400
Practice Address - Fax:801-298-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT16382251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health