Organization
KINTSUGI COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE EVANS-MCALISTER LCMHC (MENTAL HEALTH THERAPIST)
(435) 850-7402
Entity
Organization
Contact information
Practice address
150 N MAIN ST STE 204, HEBER CITY, UT 84032-1671
(435) 850-7402
(435) 538-7000
Mailing address
520 N MAIN STREET, SUITE C#448, HEBER CITY, UT 84032
(435) 850-7402
(435) 538-7000
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9056683-6004
STATE LICENSE FOR PRACTICE
UT
Enumeration date
03/28/2019
Last updated
04/22/2019
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