NPIMap

Organization Active NPI

Willow Haven Counseling LLC

  • Clinical Social Worker
  • Logan, UT
National Provider Identifier
1124676739
Registry record updated Aug 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
WILLOW HAVEN COUNSELING LLC
Practice address
255 S Main St Ste 100
Logan, UT 84321-5203
Phone
(801) 822-2109
NPI assigned
Aug 27, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Ashley Carolina Brog, LCSWNPI 1053759985
Title
Member/Therapist
Phone
(801) 822-2109

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

255 S Main St Ste 100
Logan, UT 84321-5203

Mailing address

1295 E 2100 N
North Logan, UT 84341-2035
Phone (801) 822-2109

Other names 1

  • Willow Haven Counseling - Carolina Brog, LCSW Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL NA Direct

National Provider Directory

National Provider Directory

Locations

255 S Main St
Ste 100
Logan, UT 84321
Phone (435) 764-2510

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566864000000",
    "number": "1124676739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1295 E 2100 N",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843412035",
            "telephone_number": "801-822-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 S MAIN ST STE 100",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215203",
            "telephone_number": "801-822-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW HAVEN COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-27",
        "last_updated": "2019-08-27",
        "status": "A",
        "authorized_official_last_name": "BROG",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "CAROLINA",
        "authorized_official_title_or_position": "MEMBER/THERAPIST",
        "authorized_official_telephone_number": "801-822-2109",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "NA",
            "affiliation": "N",
            "endpointDescription": "NA",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "NA",
            "address_1": "255 S Main St Ste 100",
            "city": "Logan",
            "state": "UT",
            "country_code": "US",
            "postal_code": "843215203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Willow Haven Counseling - Carolina Brog, LCSW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Logan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.