Healthcare Provider Details

I. General information

NPI: 1356945455
Provider Name (Legal Business Name): LINDEN TREE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 N 1420 E
OREM UT
84097-5484
US

IV. Provider business mailing address

831 N 1420 E
OREM UT
84097-5484
US

V. Phone/Fax

Practice location:
  • Phone: 385-225-0464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUZANNE DASTRUP
Title or Position: OWNER
Credential:
Phone: 385-225-0464