Healthcare Provider Details

I. General information

NPI: 1235002494
Provider Name (Legal Business Name): THERAPYCORP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W CANYON CREST RD STE 101
ALPINE UT
84004-2062
US

IV. Provider business mailing address

60 W CANYON CREST RD STE 101
ALPINE UT
84004-2062
US

V. Phone/Fax

Practice location:
  • Phone: 385-224-5128
  • Fax:
Mailing address:
  • Phone: 385-224-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BRANNON PATRICK
Title or Position: OWNER
Credential: LCSW, CSAT
Phone: 385-224-5128