Provider Demographics
NPI:1902204209
Name:OTR THERAPEUTIC SERVICES, PLLC
Entity Type:Organization
Organization Name:OTR THERAPEUTIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SCHEID
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:801-641-5077
Mailing Address - Street 1:2722 S CAMRON GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-1570
Mailing Address - Country:US
Mailing Address - Phone:801-641-5077
Mailing Address - Fax:801-274-8102
Practice Address - Street 1:2480 S MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-3058
Practice Address - Country:US
Practice Address - Phone:801-641-5077
Practice Address - Fax:801-274-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT287998-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty