Provider Demographics
NPI:1639895790
Name:CENTER FOR TRAUMA, RECOVERY, AND WELLNESS
Entity Type:Organization
Organization Name:CENTER FOR TRAUMA, RECOVERY, AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MEAGHAN
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:978-815-4800
Mailing Address - Street 1:929 E 11190 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5329
Mailing Address - Country:US
Mailing Address - Phone:801-215-9334
Mailing Address - Fax:
Practice Address - Street 1:929 E 11190 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5329
Practice Address - Country:US
Practice Address - Phone:801-215-9334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty