Provider Demographics
NPI:1932980026
Name:DRAPER RIDGE COUNSELING SERVICES
Entity Type:Organization
Organization Name:DRAPER RIDGE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:JUESCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:801-999-8333
Mailing Address - Street 1:12401 S 450 E UNIT B2
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7936
Mailing Address - Country:US
Mailing Address - Phone:801-999-8333
Mailing Address - Fax:
Practice Address - Street 1:12401 S 450 E UNIT B2
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7936
Practice Address - Country:US
Practice Address - Phone:801-999-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK JUESCHKE, LMFT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty