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General NPI Number Information
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NPI Number | 1649891953
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIVE CARE
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 4055 S 700 E STE 102F
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-2174
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Country | US
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Telephone | 801-618-0852
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Fax |
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Provider Business Mailing Address
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Address Line | 1187 E CHARLTON AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-2603
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Country | US
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Telephone | 928-607-4677
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | JAMIE LEIGH BUSTAMANTE
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Credential | PHD
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Telephone | 801-618-0852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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