Provider Demographics
NPI:1326267311
Name:FORDHAM, BRUCE K (LPC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:K
Last Name:FORDHAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 S 900 E STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1850
Mailing Address - Country:US
Mailing Address - Phone:801-872-5516
Mailing Address - Fax:801-212-9942
Practice Address - Street 1:3051 W MAPLE LOOP DR STE 210
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4602
Practice Address - Country:US
Practice Address - Phone:801-872-5516
Practice Address - Fax:801-872-5516
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140784-6004101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional