Provider Demographics
NPI:1205453024
Name:COPPER RIDGE COUNSELING
Entity type:Organization
Organization Name:COPPER RIDGE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-207-2692
Mailing Address - Street 1:10432 S 4000 W STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5729
Mailing Address - Country:US
Mailing Address - Phone:661-400-0208
Mailing Address - Fax:
Practice Address - Street 1:10432 S 4000 W STE B
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5729
Practice Address - Country:US
Practice Address - Phone:661-400-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty