Provider Demographics
NPI:1740502970
Name:THERAPY ON THE FLY PLLC
Entity type:Organization
Organization Name:THERAPY ON THE FLY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCWS
Authorized Official - Phone:801-458-1516
Mailing Address - Street 1:298 24TH ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1431
Mailing Address - Country:US
Mailing Address - Phone:801-458-1516
Mailing Address - Fax:435-836-2427
Practice Address - Street 1:298 24TH ST
Practice Address - Street 2:SUITE 420
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1431
Practice Address - Country:US
Practice Address - Phone:801-458-1516
Practice Address - Fax:435-836-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6068455-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427202266OtherINDIVIDUAL NPI