Cottonwood Center for Counseling

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

5170621-6004 Issued in UT

Legal business name

COTTONWOOD CENTER FOR COUNSELING

Doing business as

Family Abuse Center for Treatment

Practice address

4055 S 700 E Ste 204
Salt Lake City, UT 84107-2504

Phone

(801) 946-2323

NPI assigned

May 16, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Joseph Vicario, CMHCNPI 1548561277

Title

President

Phone

(801) 946-2323

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Family Abuse Center for Treatment Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Joseph Vicario, CMHC

  • Professional Counselor
  • Salt Lake City, UT
  • NPI 1548561277
  NPD Authorized official

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1396235156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4760 S WOODDUCK LN",
            "city": "SLC",
            "state": "UT",
            "postal_code": "841174935",
            "telephone_number": "801-946-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 S 700 E STE 204",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841072504",
            "telephone_number": "801-946-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COTTONWOOD CENTER FOR COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-16",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "VICARIO",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-946-2323",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CMHC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "UT",
            "license": "5170621-6004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13938810",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811331010",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12229378",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548561277",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Abuse Center for Treatment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Darrin Jon Cottle, PA-C
• Sara Elizabeth Cottle
• Jamie Lisbeth Cotton Joachin, RD
• Michael Brent Cotton, D.P.T
• Cottonwood Behavioral Counseling LLC
• Cottonwood Creek MSL, LLC (Cottonwood Creek)
• Cottonwood Endodontics PC
• Cottonwood Eye & Laser Clinic, P.C.
• Cottonwood Pediatric Dental (All About Smiles)
• Cottonwood Pediatric Dentistry

• Mental Health Clinic/Center (Including Community Mental Health Center) in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.