Provider Demographics
NPI:1639863095
Name:DAILY PRACTICE THERAPY
Entity Type:Organization
Organization Name:DAILY PRACTICE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLWANGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-779-5273
Mailing Address - Street 1:10808 S RIVER FRONT PKWY STE 366
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-6300
Mailing Address - Country:US
Mailing Address - Phone:808-779-5273
Mailing Address - Fax:
Practice Address - Street 1:10808 S RIVER FRONT PKWY STE 366
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-6300
Practice Address - Country:US
Practice Address - Phone:808-779-5273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health