| Cottonwood Creek Counseling | |
|
7321 S State St Ste A Midvale UT 84047-6105 | |
| (801) 878-4327 | |
| (801) 878-9280 |
| Full Name | Cottonwood Creek Counseling |
|---|---|
| Speciality | Counselor |
| Location | 7321 S State St Ste A, Midvale, Utah |
| Authorized Official Name and Position | Jennifer Fairbourn (LMFT) |
| Authorized Official Contact | 8018784327 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cottonwood Creek Counseling 7321 S State St Ste A Midvale UT 84047-6105 Ph: (801) 878-4327 | Cottonwood Creek Counseling 7321 S State St Ste A Midvale UT 84047-6105 Ph: (801) 878-4327 |
| NPI Number | 1356826036 |
|---|---|
| Provider Enumeration Date | 09/28/2018 |
| Last Update Date | 08/16/2022 |
| Certification Date | 08/16/2022 |
| Medicare PECOS PAC ID | 5294116455 |
|---|---|
| Medicare Enrollment ID | O20220719002188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356826036 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Sloane Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598734139 PECOS PAC ID: 3678556669 Enrollment ID: I20040610001170 |
| Provider Name | Patricia R Totterer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427017581 PECOS PAC ID: 6709967235 Enrollment ID: I20080122000652 |
| Provider Name | Jeffrey J Carr |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285866509 PECOS PAC ID: 1850645862 Enrollment ID: I20181109002371 |
| Provider Name | Janette M Luna |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427223601 PECOS PAC ID: 1254702459 Enrollment ID: I20230126001849 |
| Provider Name | Jennifer Fairbourn |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1992977383 PECOS PAC ID: 3173990546 Enrollment ID: I20240116002397 |
| Provider Name | Susan Fink |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891143640 PECOS PAC ID: 1153704358 Enrollment ID: I20240116003184 |
| Provider Name | Jan M Malmberg |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225193998 PECOS PAC ID: 9739565904 Enrollment ID: I20240222002589 |
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