Healthcare Provider Details

I. General information

NPI: 1881079069
Provider Name (Legal Business Name): THE OCD AND ANXIETY TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 N MAIN ST STE 100
BOUNTIFUL UT
84010-6092
US

IV. Provider business mailing address

1459 N MAIN ST STE 100
BOUNTIFUL UT
84010-6092
US

V. Phone/Fax

Practice location:
  • Phone: 801-298-2000
  • Fax:
Mailing address:
  • Phone: 801-298-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5388245-3501
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAUL JOSEPH PETERSON
Title or Position: CEO/DIRECTOR
Credential: LCSW
Phone: 385-333-6555