Healthcare Provider Details

I. General information

NPI: 1609014000
Provider Name (Legal Business Name): BLACKRIVER CONSULTING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 03/09/2011
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: 801-716-4049
Mailing address:
  • Phone: 801-596-0147
  • Fax: 801-716-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139307-3501
License Number StateUT

VIII. Authorized Official

Name: CHRISTOPHER ALAN ROBERTSON
Title or Position: PRESIDENT
Credential: L.C.S.W.
Phone: 801-596-0147