KINTSUGI COUNSELING, LLC (NPI# 1013478346) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013478346 |
| Entity Type | Organization |
| Organization Name | KINTSUGI COUNSELING, LLC |
| Practice Address |
150 N Main St Ste 204 Heber City UT 84032-1671 |
| Mailing Address |
520 N Main Street Suite C#448 Heber City UT 84032 |
| Practice Telephone | 4358507402 |
| Practice Fax Number | 4355387000 |
| Mailing Telephone | 4358507402 |
| Mailing Fax Number | 4355387000 |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2019-04-22 |
| Authorized Official Name | JACQUELINE EVANS-MCALISTER (MENTAL HEALTH THERAPIST) |
| Authorized Official Telephone | 4358507402 |
| Authorized Official Credential | LCMHC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | STATE LICENSE FOR PRACTICE | 9056683-6004 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | KINTSUGI COUNSELING, LLC | 1417 Nw 54th St, #425, Seattle, WA 98107-3571 |
| Street Address |
150 N MAIN ST STE 204 |
| City | HEBER CITY |
| State | UT |
| Zip Code | 84032-1671 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134733439 | Kelly C Cook | Student in an Organized Health Care Education/Training Program | 55 500 E, Heber, UT 84032 | 2020-09-03 |
| 1558807883 | Heber City Dental | Dentist | 345 E Gateway Drive, Suite 200, Heber City, UT 84032 | 2017-01-10 |
| 1326584921 | Deer Creek Childrens Dentistry | Dentist | 575 South 200 East, Heber City, UT 84032 | 2017-01-06 |
| 1194197871 | Ryan Hall | Physician Assistant | 150 N Main St #105, Heber City, UT 84032 | 2015-10-21 |
| 1841686631 | Jamar Romanceles Grayson | Family Medicine | 1485 Us-40 Ste G, Heber City, Ut 84032, Heber City, UT 84032 | 2015-04-08 |
| 1003218512 | Zebadia Pessetto | Physical Therapist | 380 E 1500 S Ste 102, Heber City, UT 84032 | 2014-09-16 |
| 1033471602 | Erik Mcclure | Anesthesiology | 899 E 200 S, Heber City, UT 84032 | 2012-06-11 |
| 1164716122 | Alicia M Power | Marriage & Family Therapist | 55 South 500 North, Heber City, UT 84032 | 2011-06-07 |
| 1073849873 | Ron T Dummar | Chiropractor | 325 West 600 S St. 403, Heber, UT 84032 | 2009-10-29 |
| 1407031255 | Wasatch County Health Department | Public Health or Welfare | 55 East 500 South, Heber City, UT 84032 | 2007-12-28 |
| Find all providers in zip 84032 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649819020 | Topaz Counseling Pllc | Clinic/Center | 520 Topaz Blvd Ste 203d, Delta, UT 84624-4103 | 2020-01-02 |
| 1992346704 | Anicka Inc | Clinic/Center | 3195 South Main St, Ste 260, South Salt Lake, UT 84115 | 2019-10-02 |
| 1871145227 | Pinyon Pine Counseling | Clinic/Center | 1240 E 100 S Bldg 23, Saint George, UT 84790-3001 | 2019-07-15 |
| 1225590755 | Amy Henderson Lcsw LLC | Clinic/Center | 4055 S 700 E Ste 102a, Salt Lake City, UT 84107-2174 | 2019-04-03 |
| 1205314747 | North Star Counseling Services | Clinic/Center | 298 24th St Ste 204, Ogden, UT 84401-1870 | 2018-08-06 |
| 1194223867 | Cottonwood Behavioral Counseling LLC | Clinic/Center | 6337 S Highland Dr # 227 Suite 227, Salt Lake City, UT 84121-8558 | 2018-01-29 |
| 1174021281 | Insight Recovery Cedar City LLC | Clinic/Center | 535 S Main St Ste 2, Cedar City, UT 84720-3576 | 2018-01-24 |
| 1265941702 | Silver Creek Psychiatry | Clinic/Center | 1480 E 820 N, Orem, UT 84097-5481 | 2017-09-27 |
| 1336533348 | Salt Lake Weight Counseling | Clinic/Center | 7105 S. Highland Dr. Ste 202, Salt Lake City, UT 84121 | 2015-03-27 |
| 1942690656 | Hughes Therapy 1 | Clinic/Center | 3585 N University Ave Ste 350, Provo, UT 84604-6608 | 2015-02-02 |
| Find all providers with the same taxonomy | ||||
| City | HEBER CITY |
| Zip Code | 84032 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.