Provider Demographics
NPI:1548658586
Name:WASATCH PSYCHOTHERAPY AND CONSULTING
Entity type:Organization
Organization Name:WASATCH PSYCHOTHERAPY AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-232-6482
Mailing Address - Street 1:684 E VINE ST
Mailing Address - Street 2:4B1
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5548
Mailing Address - Country:US
Mailing Address - Phone:385-232-6482
Mailing Address - Fax:
Practice Address - Street 1:684 E VINE ST
Practice Address - Street 2:4B1
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5548
Practice Address - Country:US
Practice Address - Phone:385-232-6482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70958721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty