| Organization Name: | THE PHOENIX RECOVERY & COUNSELING CENTER - RIVERDALE |
| NPI Number: | 1346600293 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRAD RANDALL CHRISTENSEN (OPERATIONS DIRECTOR) |
| Mailing Address: | 5133 S 1500 W Riverdale |
| State: | UT US |
| Postal Code: | 844053926 |
| Phone Number: | 8013920895 |
| Fax Number: | 8016192016 |
| NPI Enumeration Date: | 03/03/2016 |
| NPI Last Update Date: | 03/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 19186 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |