Organization Active NPI

Keystone Family Counseling, PLLC

  • Clinical Social Worker
  • Payson, UT
National Provider Identifier
1194271601
Registry record updated Dec 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
7442576-3501 Issued in UT
Legal business name
KEYSTONE FAMILY COUNSELING, PLLC
Practice address
1172 E 100 N
Suite 8
Payson, UT 84651-1667
Phone
(801) 380-9305
NPI assigned
Aug 25, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2016

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

Authorized official

Name
Robert Clegg, LCSWNPI 1023284262
Title
Owner
Phone
(801) 380-9305

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: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 7442576-3501 UT Primary

Addresses

Primary practice location

1172 E 100 N
Suite 8
Payson, UT 84651-1667

Mailing address

1172 E 100 N
Suite 8
Payson, UT 84651-1667
Phone (801) 380-9305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161109002670 UT Part B Supplier - Clinic/Group Practice 8224317581 Receives reassigned benefits from 1 practitioner
Practice locations: Alpine, UT; Payson, UT

National Provider Directory

National Provider Directory

Locations

165 W Canyon Crest Rd
Ste 210
Alpine, UT 84004
Phone (801) 772-0686

1172 E 100 N
Ste 8
Payson, UT 84651
Phone (801) 380-9305

Practitioners & affiliated clinicians

Practitioners 5

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": "1472083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481155200000",
    "number": "1194271601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1172 E 100 N",
            "address_2": "SUITE 8",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846511667",
            "telephone_number": "801-380-9305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1172 E 100 N",
            "address_2": "SUITE 8",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846511667",
            "telephone_number": "801-380-9305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE FAMILY COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-25",
        "last_updated": "2016-12-08",
        "status": "A",
        "authorized_official_last_name": "CLEGG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-380-9305",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "7442576-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Payson, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.