Provider Demographics
NPI:1154201325
Name:TRIFECTA PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:TRIFECTA PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW, ATR-BC
Authorized Official - Phone:347-759-2265
Mailing Address - Street 1:2095 E 4500 S
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4319
Mailing Address - Country:US
Mailing Address - Phone:347-759-2265
Mailing Address - Fax:
Practice Address - Street 1:2095 E 4500 S
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4319
Practice Address - Country:US
Practice Address - Phone:347-759-2265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty