| Provo Counseling Center | |
|
3325 N University Ave Ste 300 Provo UT 84604-7412 | |
| (801) 472-7134 | |
| (801) 743-7599 |
| Full Name | Provo Counseling Center |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3325 N University Ave Ste 300, Provo, Utah |
| Authorized Official Name and Position | Cory Brad Dennis (OWNER/OPERATOR) |
| Authorized Official Contact | 8014727134 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provo Counseling Center 3325 N University Ave Ste 300 Provo UT 84604-7412 Ph: (801) 472-7134 | Provo Counseling Center 3325 N University Ave Ste 300 Provo UT 84604-7412 Ph: (801) 472-7134 |
| NPI Number | 1992467963 |
|---|---|
| Provider Enumeration Date | 10/07/2021 |
| Last Update Date | 08/25/2023 |
| Certification Date | 08/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992467963 | NPI | - | NPPES |
| 1992467963 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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