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Organization
COTTONWOOD CENTER FOR COUNSELING
Active
Organization
COTTONWOOD CENTER FOR COUNSELING
Active
Other names
Family Abuse Center for Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW JOSEPH VICARIO CMHC (PRESIDENT)
(801) 946-2323
Entity
Organization
Contact information
Practice address
4055 S 700 E STE 204, SALT LAKE CITY, UT 84107-2504
(801) 946-2323
Mailing address
4760 S WOODDUCK LN, SLC, UT 84117-4935
(801) 946-2323
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
5170621-6004
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12229378
CAQH
UT
01
—
13938810
CAQH
UT
05
—
1548561277
—
UT
05
—
1811331010
—
UT
Enumeration date
05/16/2018
Last updated
09/16/2021
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