| Ridgeline Counseling | |
|
6778 S 700 E Midvale UT 84047-1359 | |
| (541) 287-0795 | |
| Not Available |
| Full Name | Ridgeline Counseling |
|---|---|
| Speciality | Counselor |
| Location | 6778 S 700 E, Midvale, Utah |
| Authorized Official Name and Position | Kenji Kihara Hammon (OWNER) |
| Authorized Official Contact | 5412870795 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ridgeline Counseling 6778 S 700 E Midvale UT 84047-1359 Ph: (541) 287-0795 | Ridgeline Counseling 6778 S 700 E Midvale UT 84047-1359 Ph: (541) 287-0795 |
| NPI Number | 1295420503 |
|---|---|
| Provider Enumeration Date | 04/11/2023 |
| Last Update Date | 05/15/2023 |
| Certification Date | 05/15/2023 |
| Medicare PECOS PAC ID | 9638526387 |
|---|---|
| Medicare Enrollment ID | O20231117000244 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295420503 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kenji Kihara Hammon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659902872 PECOS PAC ID: 8426422551 Enrollment ID: I20230313001657 |
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