Provider Demographics
NPI:1720262025
Name:THERAPEUTIC CENTER FOR CHANGE PC
Entity Type:Organization
Organization Name:THERAPEUTIC CENTER FOR CHANGE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-668-0490
Mailing Address - Street 1:1466 N HIGHWAY 89 STE 230
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2738
Mailing Address - Country:US
Mailing Address - Phone:801-668-0490
Mailing Address - Fax:801-737-0099
Practice Address - Street 1:1466 N HIGHWAY 89 STE 230
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2738
Practice Address - Country:US
Practice Address - Phone:801-668-0490
Practice Address - Fax:801-737-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty