Healthcare Provider Details

I. General information

NPI: 1811751126
Provider Name (Legal Business Name): OGDEN THERAPY COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 24TH ST STE 1A
OGDEN UT
84401-2580
US

IV. Provider business mailing address

2127 N 600 E
NORTH OGDEN UT
84414-2811
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-5225
  • Fax:
Mailing address:
  • Phone: 801-682-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY SHAPIRO
Title or Position: OWNER
Credential: LCSW, MPA
Phone: 801-475-5225