RED WILLOW IOP, PLLC (NPI# 1477189900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477189900 |
| Entity Type | Organization |
| Organization Name | RED WILLOW IOP, PLLC |
| Practice Address |
1425 S 700 E Ste 102 Salt Lake City UT 84105-2125 |
| Practice Telephone | 3853130055 |
| Mailing Telephone | 3853130055 |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2020-03-16 |
| Authorized Official Name | JAMES OTT (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8015566007 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | Y |
| Parent Organization Name | RED WILLOW COUNSELING AND RECOVERY PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Red Willow Counseling and Recovery | Doing Business As Name - Organization |
| Street Address |
1425 S 700 E STE 102 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84105-2125 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295807378 | James Kevin Ott | Social Worker | 1425 S 700 E Ste 102, Salt Lake City, UT 84105-2125 | 2006-11-14 |
| 1033757307 | Geoffrey Olsen | Counselor | 1425 S 700 E Ste 102, Salt Lake City, UT 84105-2125 | 2019-12-17 |
| 1740750934 | Robert G Smith | Counselor | 1425 S 700 E Ste 102, Salt Lake City, UT 84105-2125 | 2018-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285106237 | Laiyan H Bawadeen | Counselor | 1425 700 E Suite #102, Salt Lake City, UT 84105 | 2018-12-31 |
| 1639644255 | Claire Elizabeth Gray | Marriage & Family Therapist | 1425 700 East, Salt Lake City, UT 84105 | 2018-10-10 |
| 1083089643 | Celisa Packer | Social Worker | 2020 E Lake St, Salt Lake City, UT 84105 | 2015-12-08 |
| 1083052963 | Christina Elizabeth Burton | Nurse Practitioner | 1008 S 1100 E, Apt 6, Salt Lake City, UT 84105 | 2013-06-12 |
| 1649548355 | Leland Burt Cowan | Surgery | 1405 Princeton Ave, Salt Lake City, UT 84105 | 2011-12-08 |
| 1639460355 | Sally Cathleen Webster | Counselor | 1248 Yale Avenue, Salt Lake City, UT 84105 | 2011-04-28 |
| 1912205105 | Melissa Wilson | Case Manager/Care Coordinator | 1522 S 1100 E, Salt Lake City, UT 84105 | 2011-03-11 |
| 1013215789 | Tamara Marie Wright | Counselor | 1996 Lake St, Salt Lake City, UT 84105 | 2011-03-04 |
| 1144527243 | Crystal Nicole Garduno | Counselor | 1522 South 1100 East, Salt Lake City, UT 84105 | 2011-02-25 |
| 1508011180 | Keith Elliott | Anesthesiology | 1552 South 1000 East, Salt Lake City, UT 84105 | 2008-11-24 |
| Find all providers in zip 84105 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124666870 | One Voice Recovery | Clinic/Center | 1400 S 1100 E, Salt Lake City, UT 84105-2435 | 2019-12-12 |
| 1316392897 | Nuway Recovery, LLC | Clinic/Center | 4925 S 900 E, Salt Lake City, UT 84117-5784 | 2016-05-03 |
| 1578803748 | Recovery Ways, LLC | Clinic/Center | 1174 East 2760 South, Suite #10, Salt Lake City, UT 84106 | 2013-02-25 |
| 1942502638 | Tranquility Place of Utah LLC | Clinic/Center | 160 E 800 S Ste B, Salt Lake City, UT 84111-3827 | 2010-12-01 |
| 1003997701 | Assessment, Counseling & Educational Services | Clinic/Center | 3808 S West Temple, Sutie 150, Salt Lake City, UT 84115-4446 | 2006-10-18 |
| 1033143706 | Odyssey House Inc. | Clinic/Center | 340 E 100 S, Salt Lake City, UT 84111-1702 | 2006-07-10 |
| 1265871644 | Odyssey House | Clinic/Center | 344 E 100 S, Salt Lake City, UT 84111-1700 | 2013-06-19 |
| 1639492036 | Michelle Moyes | Clinic/Center | 2001 S State St, S2300, Salt Lake City, UT 84190-0001 | 2010-03-12 |
| 1932422474 | Debbie L Scovill | Clinic/Center | 2001 S State St Ste S2300, Salt Lake City, UT 84190-2250 | 2010-03-11 |
| 1396839544 | Carleen S. Jimenez | Clinic/Center | 2001 S State St, Suite 2300, Salt Lake City, UT 84190-2250 | 2006-10-03 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84105 |
Please comment or provide details below to improve the information on RED WILLOW IOP, PLLC.
| 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.