Provider Demographics
NPI:1285766238
Name:INSTITUTE FOR COGNITIVE THERAPY
Entity type:Organization
Organization Name:INSTITUTE FOR COGNITIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW
Authorized Official - Phone:801-802-8608
Mailing Address - Street 1:560 S STATE ST
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6354
Mailing Address - Country:US
Mailing Address - Phone:801-802-8608
Mailing Address - Fax:801-221-1042
Practice Address - Street 1:560 S STATE ST
Practice Address - Street 2:SUITE G-1
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6354
Practice Address - Country:US
Practice Address - Phone:801-802-8608
Practice Address - Fax:801-221-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12366261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870621824005Medicaid