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General NPI Number Information
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NPI Number | 1386486736
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Entity Type | Organization
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Legal Business Name | COTTONWOOD MOVEMENT THERAPY
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 925 E EXECUTIVE PARK DR STE B
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City | MURRAY
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State | UT
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Zip | 84117-3545
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Country | US
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Telephone | 801-610-6801
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 712372
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84171-2372
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Country | US
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Telephone | 801-610-6801
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Fax |
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Authorized Official
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Title or Position | CLINICAL MENTAL HEALTH COUNSELOR
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Name | HALLIE YURICK
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Credential | CMHC
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Telephone | 801-610-6801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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