1699955393 NPI number — CONNECTING PLACE COUNSELING CENTER PLLC

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 1699955393 NPI number — CONNECTING PLACE COUNSELING CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTING PLACE COUNSELING CENTER PLLC
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:
Provider Other Organization Name Type Code:
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:
1699955393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2845 WILLOW WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHI
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84043-5164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-768-1725
Provider Business Mailing Address Fax Number:
801-768-1725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3375 W MAYFLOWER WAY STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHI
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84043-3135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-768-1725
Provider Business Practice Location Address Fax Number:
888-891-8164
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BASSETT
Authorized Official First Name:
DUSTIN
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
OWNER/CHEIF THERAPIST
Authorized Official Telephone Number:
801-768-1725

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  6774648-0162 , 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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