Healthcare Provider Details

I. General information

NPI: 1417581950
Provider Name (Legal Business Name): OGDEN CENTER FOR CHANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 QUINCY AVE STE 105
OGDEN UT
84403-1993
US

IV. Provider business mailing address

3670 QUINCY AVE STE 105
OGDEN UT
84403-1993
US

V. Phone/Fax

Practice location:
  • Phone: 801-781-5733
  • Fax: 801-899-6634
Mailing address:
  • Phone: 801-781-5733
  • Fax: 801-899-6634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DAVID PAUL JOHNSON
Title or Position: PSYCHOLOGIST/CO-OWNER
Credential: PHD
Phone: 801-781-5733