Healthcare Provider Details

I. General information

NPI: 1447665047
Provider Name (Legal Business Name): CENTER FOR EXPRESSIVE THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 E ELLISONWOODS AVE
COTTONWOOD HEIGHTS UT
84121-2652
US

IV. Provider business mailing address

2450 E ELLISONWOODS AVE
COTTONWOOD HEIGHTS UT
84121-2652
US

V. Phone/Fax

Practice location:
  • Phone: 801-867-5798
  • Fax:
Mailing address:
  • Phone: 801-867-5798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: TAMARA OLLERTON
Title or Position: DIRECTOR
Credential: MT-B C
Phone: 801-867-5798