=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154707438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUCCESSFUL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2015
-----------------------------------------------------
Last Update Date | 08/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 275 W 200 N STE 203
-----------------------------------------------------
City | LINDON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84042-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-787-7735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 275 W 200 N STE 203
-----------------------------------------------------
City | LINDON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84042-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-787-7735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | SCOTT DOWNS
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 801-787-7735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 78624483902
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------