Healthcare Provider Details

I. General information

NPI: 1619053949
Provider Name (Legal Business Name): CHRISTOPHER BOUWHUIS M.S., L.M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 26TH STREET
OGDEN UT
84401-3105
US

IV. Provider business mailing address

1188 NAYON DR
LAYTON UT
84040-2830
US

V. Phone/Fax

Practice location:
  • Phone: 801-625-3605
  • Fax: 801-625-3615
Mailing address:
  • Phone: 801-593-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5812224-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: