Provider Demographics
NPI:1548815335
Name:MOUNTAIN PATHS COUNSELING LLC
Entity type:Organization
Organization Name:MOUNTAIN PATHS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-556-9106
Mailing Address - Street 1:5882 S 900 E STE 303
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1693
Mailing Address - Country:US
Mailing Address - Phone:801-214-1565
Mailing Address - Fax:801-214-1565
Practice Address - Street 1:5882 S 900 E STE 303
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1693
Practice Address - Country:US
Practice Address - Phone:801-214-1565
Practice Address - Fax:801-214-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty