Provider Demographics
NPI:1891576005
Name:CENTER FOR RESILIENCE LEADERSHIP
Entity Type:Organization
Organization Name:CENTER FOR RESILIENCE LEADERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:O'GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-952-2207
Mailing Address - Street 1:1508 SPRINGDELL CIR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-9632
Mailing Address - Country:US
Mailing Address - Phone:410-952-2207
Mailing Address - Fax:
Practice Address - Street 1:1508 SPRINGDELL CIR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-9632
Practice Address - Country:US
Practice Address - Phone:202-258-3711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty