Provider Demographics
NPI:1477799567
Name:LIFE CHANGING THERAPY
Entity Type:Organization
Organization Name:LIFE CHANGING THERAPY
Other - Org Name:RICHARD H. BASHAW LCSW, LLC AND ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AGENCY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HOLLIS
Authorized Official - Last Name:BASHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:801-918-9688
Mailing Address - Street 1:1800 S WEST TEMPLE
Mailing Address - Street 2:SUITE A332
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1851
Mailing Address - Country:US
Mailing Address - Phone:801-918-9688
Mailing Address - Fax:801-446-7874
Practice Address - Street 1:1800 S WEST TEMPLE
Practice Address - Street 2:SUITE A332
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1851
Practice Address - Country:US
Practice Address - Phone:801-918-9688
Practice Address - Fax:801-446-7874
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-20
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT06831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty