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Organization
DOUG AND BETTY FORD COUNSELING LLC
Active
Organization
DOUG AND BETTY FORD COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL IPSON (BILLNG MANAGER)
(801) 921-9495
Entity
Organization
Contact information
Practice address
216 COUGAR CIR, ELK RIDGE, UT 84651-9565
(801) 921-9495
Mailing address
PO BOX 222, SALEM, UT 84653-0222
(801) 921-9495
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3315546004
UT
1041C0700X
Clinical Social Worker
49290043501
UT
Other
Enumeration date
02/26/2015
Last updated
02/26/2015
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