Organization
FIDDLE CREEK COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACLYN RANDOLPH (LCSW)
(208) 547-7762
Entity
Organization
Contact information
Practice address
475 N 300 W STE 16, KAYSVILLE, UT 84037-3110
(208) 547-7762
Mailing address
475 N 300 W STE 16, KAYSVILLE, UT 84037-3110
(208) 547-7762
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/03/2024
Last updated
01/03/2024
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