Provider Demographics
NPI:1871335158
Name:THERAPEACE COUNSELING
Entity type:Organization
Organization Name:THERAPEACE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-855-6420
Mailing Address - Street 1:2975 EXEC PKWY STE 186
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-9425
Mailing Address - Country:US
Mailing Address - Phone:801-855-6420
Mailing Address - Fax:
Practice Address - Street 1:2975 EXEC PKWY # 274
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-9642
Practice Address - Country:US
Practice Address - Phone:801-855-6420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)