Healthcare Provider Details

I. General information

NPI: 1437062759
Provider Name (Legal Business Name): LINCOLN BRADSHAW COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6936 S PROMENADE DR STE 103
COTTONWOOD HEIGHTS UT
84121-5699
US

IV. Provider business mailing address

6936 S PROMENADE DR STE 103
COTTONWOOD HEIGHTS UT
84121-5699
US

V. Phone/Fax

Practice location:
  • Phone: 801-652-1278
  • Fax:
Mailing address:
  • Phone: 801-652-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: LINCOLN BRADSHAW
Title or Position: OWNER/THERAPIST
Credential:
Phone: 801-652-1278