I Promise Foundation

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

19034 Issued in UT

Legal business name

I PROMISE FOUNDATION

Practice address

3521 N University Ave
Suite 225
Provo, UT 84604-4418

Phone

(801) 472-9780

Fax

(801) 426-4615

NPI assigned

Feb 23, 2012

Organization subpart

No

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

Authorized official

Name

Kendra Bernal

Title

Executive Director

Phone

(801) 472-9780

Specialties & licenses 15

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329955200000",
    "number": "1144594003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 W BULLDOG BLVD # 443",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846042546",
            "telephone_number": "801-472-9780",
            "fax_number": "801-426-4615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3521 N UNIVERSITY AVE",
            "address_2": "SUITE 225",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044418",
            "telephone_number": "801-472-9780",
            "fax_number": "801-426-4615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I PROMISE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-23",
        "last_updated": "2012-02-23",
        "status": "A",
        "authorized_official_last_name": "BERNAL",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-472-9780"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "19034",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, School",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "102L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychoanalyst",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "UT",
            "license": "19034",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "UT",
            "license": "19034",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF UTAH - HEALTH & HUMAN SERVICES LICENSE",
            "identifier": "19034",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Provo, UT
• Providers in Provo, UT by specialty
• Addiction (Substance Use Disorder) Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2012; 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.