Provider Demographics
NPI:1053583435
Name:SEQUOIA COUNSELING SERVICES
Entity type:Organization
Organization Name:SEQUOIA COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:TABISH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-463-7520
Mailing Address - Street 1:3378 SOUTH 900 EAST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2070
Mailing Address - Country:US
Mailing Address - Phone:801-463-7520
Mailing Address - Fax:801-463-7525
Practice Address - Street 1:3378 SOUTH 900 EAST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2070
Practice Address - Country:US
Practice Address - Phone:801-463-7520
Practice Address - Fax:801-463-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134757101YA0400X
UT134571041C0700X
UT189221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005569802OtherMEDICARE A
UT52836974304001OtherBLUE CROSS BLUE SHEILD