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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