1477799567 NPI number — LIFE CHANGING THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477799567 NPI number — LIFE CHANGING THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE CHANGING THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RICHARD H. BASHAW LCSW, LLC AND ASSOCIATES
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477799567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 S WEST TEMPLE
Provider Second Line Business Mailing Address:
SUITE A332
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84115-1851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-918-9688
Provider Business Mailing Address Fax Number:
801-446-7874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 S WEST TEMPLE
Provider Second Line Business Practice Location Address:
SUITE A332
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84115-1851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-918-9688
Provider Business Practice Location Address Fax Number:
801-446-7874
Provider Enumeration Date:
12/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BASHAW
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
HOLLIS
Authorized Official Title or Position:
AGENCY MANAGER
Authorized Official Telephone Number:
801-918-9688

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0683 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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