| Woodhaven At Millcreek Psychotherapy Services | |
|
1398 E Luck Ln Millcreek UT 84106-2944 | |
| (801) 712-1441 | |
| Not Available |
| Full Name | Woodhaven At Millcreek Psychotherapy Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 1398 E Luck Ln, Millcreek, Utah |
| Authorized Official Name and Position | Kathy Wickersham (OWNER) |
| Authorized Official Contact | 8017121441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Woodhaven At Millcreek Psychotherapy Services 1398 E Luck Ln Millcreek UT 84106-2944 Ph: (801) 712-1441 | Woodhaven At Millcreek Psychotherapy Services 1398 E Luck Ln Millcreek UT 84106-2944 Ph: (801) 712-1441 |
| NPI Number | 1578207981 |
|---|---|
| Provider Enumeration Date | 04/21/2022 |
| Last Update Date | 04/21/2022 |
| Certification Date | 04/21/2022 |
| Medicare PECOS PAC ID | 5698205367 |
|---|---|
| Medicare Enrollment ID | O20250211000517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578207981 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kathy Wickersham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912156431 PECOS PAC ID: 6507396272 Enrollment ID: I20250211000629 |
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