Provider Demographics
NPI:1295025575
Name:ATTRIDGE, MARY CHRISTENA (CMHC, ATR-BC, ATCS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTENA
Last Name:ATTRIDGE
Suffix:
Gender:F
Credentials:CMHC, ATR-BC, ATCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 S 900 E STE 105
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1710
Mailing Address - Country:US
Mailing Address - Phone:801-305-3171
Mailing Address - Fax:801-904-3632
Practice Address - Street 1:6770 S 900 E STE 105
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1710
Practice Address - Country:US
Practice Address - Phone:801-305-3171
Practice Address - Fax:801-904-3632
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
06-009221700000X
UT9022525-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
06-009OtherATR-BC, ATCS
UT9022525-6004OtherCMHC LICENSE