NPIMap

Organization Active NPI

Sundance Canyon Therapy, Coaching, and Consulting

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Provo, UT
National Provider Identifier
1750806519
Registry record updated Aug 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
10471569-0160 Issued in UT
Legal business name
SUNDANCE CANYON THERAPY, COACHING, AND CONSULTING
Practice address
180 N University Ave Ste 270
Provo, UT 84601-5648
Phone
(801) 678-4198
NPI assigned
Aug 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2017

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

Authorized official

Name
Mandy Erickson, LCMHCNPI 1518378785
Title
Therapist
Phone
(801) 678-4198

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 10471569-0160 UT Primary

Addresses

Primary practice location

180 N University Ave Ste 270
Provo, UT 84601-5648

Mailing address

4832 W Firmont Dr
South Jordan, UT 84009-8291
Phone (801) 678-4198

National Provider Directory

National Provider Directory

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": "1502582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502582400000",
    "number": "1750806519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4832 W FIRMONT DR",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840098291",
            "telephone_number": "801-678-4198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 N UNIVERSITY AVE STE 270",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846015648",
            "telephone_number": "801-678-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE CANYON THERAPY, COACHING, AND CONSULTING",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-13",
        "last_updated": "2017-08-13",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "MANDY",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "801-678-4198",
        "authorized_official_credential": "LCMHC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "UT",
            "license": "10471569-0160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2017; 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.