Healthcare Provider Details

I. General information

NPI: 1033013156
Provider Name (Legal Business Name): NORTHSTAR BEHAVIORAL HEALTH AND RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 N MCLAWS AVE
LAYTON UT
84040-5776
US

IV. Provider business mailing address

2647 N MCLAWS AVE
LAYTON UT
84040-5776
US

V. Phone/Fax

Practice location:
  • Phone: 801-842-7365
  • Fax:
Mailing address:
  • Phone:
  • 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: ELIZABETH TOM
Title or Position: OWNER
Credential: PSY.D, LCSW
Phone: 801-842-7365