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Organization

MT GROVE COUNSELING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KATHERINE B BRUNER LCMHC (CLINICAL DIRECTOR)
(801) 636-3036
Entity
Organization

Contact information

Practice address
66 E STATE RD, PLEASANT GROVE, UT 84062-2637
(801) 404-0064
Mailing address
66 E STATE RD, PLEASANT GROVE, UT 84062-2637
(801) 404-0064

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
103T00000X
Psychologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1922523281
NPI
Enumeration date
02/12/2019
Last updated
04/29/2022
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