Provider Demographics
NPI:1861809709
Name:WASATCH COMMUNITY COUNSELING
Entity type:Organization
Organization Name:WASATCH COMMUNITY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:435-709-8849
Mailing Address - Street 1:150 N MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-1671
Mailing Address - Country:US
Mailing Address - Phone:435-709-8849
Mailing Address - Fax:435-657-9983
Practice Address - Street 1:150 N MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1671
Practice Address - Country:US
Practice Address - Phone:435-709-8849
Practice Address - Fax:435-657-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT75862893902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1164716122Medicaid