| Mulligan Counseling Services, Pllc | |
|
10808 S River Front Pkwy South Jordan UT 84095-5759 | |
| (801) 984-6881 | |
| Not Available |
| Full Name | Mulligan Counseling Services, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 10808 S River Front Pkwy, South Jordan, Utah |
| Authorized Official Name and Position | Brandon Johnson (OWNER) |
| Authorized Official Contact | 8019846881 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mulligan Counseling Services, Pllc 11411 S Holly Springs Dr South Jordan UT 84009-1278 Ph: (801) 984-6881 | Mulligan Counseling Services, Pllc 10808 S River Front Pkwy South Jordan UT 84095-5759 Ph: (801) 984-6881 |
| NPI Number | 1013601244 |
|---|---|
| Provider Enumeration Date | 06/08/2023 |
| Last Update Date | 06/08/2023 |
| Certification Date | 06/08/2023 |
| Medicare PECOS PAC ID | 9739528514 |
|---|---|
| Medicare Enrollment ID | O20240412000899 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013601244 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Brandon Jay Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497419501 PECOS PAC ID: 0648619429 Enrollment ID: I20240412001019 |
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