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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