| Support One Health Services | |
|
15041 S Gallant Dr Bluffdale UT 84065-4987 | |
| (925) 565-6414 | |
| Not Available |
| Full Name | Support One Health Services |
|---|---|
| Speciality | Counselor |
| Location | 15041 S Gallant Dr, Bluffdale, Utah |
| Authorized Official Name and Position | Craig Baker (DIRECTOR) |
| Authorized Official Contact | 9255656414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Support One Health Services 15041 S Gallant Dr Bluffdale UT 84065-4987 Ph: () - | Support One Health Services 15041 S Gallant Dr Bluffdale UT 84065-4987 Ph: (925) 565-6414 |
| NPI Number | 1922643949 |
|---|---|
| Provider Enumeration Date | 11/13/2019 |
| Last Update Date | 11/13/2019 |
| Medicare PECOS PAC ID | 3577975382 |
|---|---|
| Medicare Enrollment ID | O20201221001728 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922643949 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tracie Lynn Hoffman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831337104 PECOS PAC ID: 6901146976 Enrollment ID: I20190329001069 |
| Provider Name | Andrea Christina Bai |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205073129 PECOS PAC ID: 5193190825 Enrollment ID: I20230412000938 |
| Provider Name | Craig Baker |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1184250300 PECOS PAC ID: 7012329824 Enrollment ID: I20240108003177 |
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