Healthcare Provider Details

I. General information

NPI: 1639060155
Provider Name (Legal Business Name): UTAH GROUP THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W 2600 S STE 340
BOUNTIFUL UT
84010-7768
US

IV. Provider business mailing address

533 W 2600 S STE 340
BOUNTIFUL UT
84010-7768
US

V. Phone/Fax

Practice location:
  • Phone: 801-210-8038
  • Fax:
Mailing address:
  • Phone: 801-210-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL THOMAS CALLISTER
Title or Position: OWNER
Credential: PHD, CMHC, CGP
Phone: 801-210-8038