Healthcare Provider Details

I. General information

NPI: 1487795878
Provider Name (Legal Business Name): CENTER FOR TRANSPERSONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 FASHION BLVD SUITE 250
MURRAY UT
84107-6159
US

IV. Provider business mailing address

5801 FASHION BLVD SUITE 250
MURRAY UT
84107-6159
US

V. Phone/Fax

Practice location:
  • Phone: 801-596-0147
  • Fax:
Mailing address:
  • Phone: 801-596-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. DENISE MARIE BOELENS
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 801-596-0147