# MOUNT OLYMPUS COUNSELING CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053910331
- **Authorized official:** KENNETH DAVID ROACH ED.D, LCMHC (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (801) 792-7028

## Contact information

- **Practice address:** 4525 S 2300 E STE 102, HOLLADAY, UT 84117-4682
- **Practice address phone:** (801) 860-7818
- **Mailing address:** 4525 S 2300 E STE 102, HOLLADAY, UT 84117-4682
- **Mailing address phone:** (801) 860-7818

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |

## Other

- **Enumeration date:** 10/19/2020
- **Last updated:** 10/19/2020