Provider Demographics
NPI:1609751536
Name:CANYON CREST COUNSELING LLC
Entity type:Organization
Organization Name:CANYON CREST COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERD
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-557-7218
Mailing Address - Street 1:2549 E ALTAMONT CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-3301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10416 S 1055 W STE 201
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-1503
Practice Address - Country:US
Practice Address - Phone:435-339-4758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)