Organization
I PROMISE FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDRA BERNAL (EXECUTIVE DIRECTOR)
(801) 472-9780
Entity
Organization
Contact information
Practice address
3521 N UNIVERSITY AVE, SUITE 225, PROVO, UT 84604-4418
(801) 472-9780
(801) 426-4615
Mailing address
223 W BULLDOG BLVD # 443, PROVO, UT 84604-2546
(801) 472-9780
(801) 426-4615
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19034
UT
101YM0800X
Mental Health Counselor
19034
UT
101YP1600X
Pastoral Counselor
19034
UT
101YP2500X
Professional Counselor
19034
UT
101YS0200X
School Counselor
19034
UT
102L00000X
Psychoanalyst
19034
UT
103TA0400X
Addiction (Substance Use Disorder) Psychologist
19034
UT
103TB0200X
Cognitive & Behavioral Psychologist
19034
UT
103TC1900X
Counseling Psychologist
19034
UT
103TP0016X
Prescribing (Medical) Psychologist
19034
UT
103TP2701X
Group Psychotherapy Psychologist
19034
UT
1041C0700X
Clinical Social Worker
19034
UT
106H00000X
Marriage & Family Therapist
19034
UT
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
19034
UT
261QM0850X
Adult Mental Health Clinic/Center
19034
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19034
STATE OF UTAH - HEALTH & HUMAN SERVICES LICENSE
UT
Enumeration date
02/23/2012
Last updated
02/23/2012
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