MEDICARE: GOOD THERAPY PLACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1942043757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD THERAPY PLACE

Provider Business Mailing Address
First Line	:	2666 S 2000 E STE 101
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2666 S 2000 E STE 101
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1721
Country	:	US
Telephone Number	:	385-217-7126
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATALIE LANHAM
Credential	:	DSW, LCSW
Telephone Number	:	385-217-7126

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/18/2024

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Directions to “GOOD THERAPY PLACE ” Practice Location

Language	Start Address	Practice Location

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