Provider Demographics
NPI:1174302129
Name:UTAH PHOENIX COUNSELING
Entity type:Organization
Organization Name:UTAH PHOENIX COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELENA
Authorized Official - Middle Name:JEANINE
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-389-7306
Mailing Address - Street 1:3712 W 2700 S
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-7775
Mailing Address - Country:US
Mailing Address - Phone:385-389-7306
Mailing Address - Fax:
Practice Address - Street 1:3712 W 2700 S
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-7775
Practice Address - Country:US
Practice Address - Phone:385-389-7306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty