Provider Demographics
NPI:1265709844
Name:SOUTH POINT COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:SOUTH POINT COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELENE
Authorized Official - Middle Name:SALLUM
Authorized Official - Last Name:DALANHESE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-403-7345
Mailing Address - Street 1:1206 W SOUTH JORDAN PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5519
Mailing Address - Country:US
Mailing Address - Phone:801-302-3801
Mailing Address - Fax:801-302-7248
Practice Address - Street 1:1206 W SOUTH JORDAN PKWY STE D
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5519
Practice Address - Country:US
Practice Address - Phone:801-302-3801
Practice Address - Fax:801-302-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-25
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5222307-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000072357OtherMEDICARE PTAN