Healthcare Provider Details

I. General information

NPI: 1962168534
Provider Name (Legal Business Name): BSP UTAH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 36TH ST STE 204
OGDEN UT
84403-2049
US

IV. Provider business mailing address

1140 36TH ST STE 204
OGDEN UT
84403-2049
US

V. Phone/Fax

Practice location:
  • Phone: 385-424-0134
  • Fax:
Mailing address:
  • Phone: 385-424-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RACHELLE STEED
Title or Position: OWNER
Credential: LCSW
Phone: 801-589-9121