NPIMap

Organization Active NPI

Provo Counseling Center

  • Clinical Social Worker
  • Provo, UT
National Provider Identifier
1992467963
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
PROVO COUNSELING CENTER
Practice address
3325 N University Ave Ste 300
Provo, UT 84604-7412
Phone
(801) 472-7134
Fax
(801) 743-7599
NPI assigned
Oct 7, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Authorized official

Name
Cory Brad Dennis, PHC LCSWNPI 1922324573
Title
Owner/Operator
Phone
(801) 472-7134

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3325 N University Ave Ste 300
Provo, UT 84604-7412

Mailing address

3325 N University Ave Ste 300
Provo, UT 84604-7412
Phone (801) 472-7134

Other identifiers 1

IdentifierTypeStateIssuer
1992467963MedicaidUT

Other names 1

  • Provo Counseling Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Provo Counseling Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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": "1633564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1992467963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 N UNIVERSITY AVE STE 300",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846047412",
            "telephone_number": "801-472-7134",
            "fax_number": "801-743-7599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3325 N UNIVERSITY AVE STE 300",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846047412",
            "telephone_number": "801-472-7134",
            "fax_number": "801-743-7599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVO COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-07",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A",
        "authorized_official_last_name": "DENNIS",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "BRAD",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "801-472-7134",
        "authorized_official_credential": "PHC LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992467963",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provo Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 25, 2023; 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.