Healthcare Provider Details

I. General information

NPI: 1639863095
Provider Name (Legal Business Name): DAILY PRACTICE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10808 S RIVER FRONT PKWY STE 366
SOUTH JORDAN UT
84095-6300
US

IV. Provider business mailing address

10808 S RIVER FRONT PKWY STE 366
SOUTH JORDAN UT
84095-6300
US

V. Phone/Fax

Practice location:
  • Phone: 808-779-5273
  • Fax:
Mailing address:
  • Phone: 808-779-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA ELLWANGER
Title or Position: OWNER, THERAPIST
Credential: LCSW
Phone: 808-779-5273