Provider Demographics
NPI:1356588834
Name:BWL ENTERPRISES INC
Entity type:Organization
Organization Name:BWL ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LUKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-329-5872
Mailing Address - Street 1:4623 S 600 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3903
Mailing Address - Country:US
Mailing Address - Phone:801-329-5872
Mailing Address - Fax:
Practice Address - Street 1:925 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE E
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-3581
Practice Address - Country:US
Practice Address - Phone:801-329-5872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3492833501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty