Provider Demographics
NPI:1063685295
Name:WHITEHAWK CONSULTING, P.C.
Entity Type:Organization
Organization Name:WHITEHAWK CONSULTING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOELENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-913-5543
Mailing Address - Street 1:5801 FASHION BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6159
Mailing Address - Country:US
Mailing Address - Phone:801-913-5543
Mailing Address - Fax:
Practice Address - Street 1:5801 FASHION BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6159
Practice Address - Country:US
Practice Address - Phone:801-913-5543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110944-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0062939Medicare PIN