1285766238 NPI number — INSTITUTE FOR COGNITIVE THERAPY

Table of content: (NPI 1285766238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285766238 NPI number — INSTITUTE FOR COGNITIVE THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE FOR COGNITIVE THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285766238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 S STATE ST
Provider Second Line Business Mailing Address:
SUITE G-1
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84058-6354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-802-8608
Provider Business Mailing Address Fax Number:
801-221-1042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 S STATE ST
Provider Second Line Business Practice Location Address:
SUITE G-1
Provider Business Practice Location Address City Name:
OREM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84058-6354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-802-8608
Provider Business Practice Location Address Fax Number:
801-221-1042
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASTLETON
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
801-802-8608

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  12366 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QR0405X , with the licence number: 12366 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 870621824005 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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