Healthcare Provider Details

I. General information

NPI: 1407760713
Provider Name (Legal Business Name): SWITCHBACK THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S 700 E STE 2E
SALT LAKE CITY UT
84102-2854
US

IV. Provider business mailing address

319 E HIDDEN GARDEN LN
SOUTH SALT LAKE UT
84115-3648
US

V. Phone/Fax

Practice location:
  • Phone: 801-436-7823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES MASON
Title or Position: THERAPIST
Credential: CMHC, LPC
Phone: 616-510-8019