Provider Demographics
NPI:1548924095
Name:BLUE SPRUCE THERAPY LLC
Entity type:Organization
Organization Name:BLUE SPRUCE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSW
Authorized Official - Phone:801-675-8583
Mailing Address - Street 1:576 W 2600 S
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4542
Mailing Address - Country:US
Mailing Address - Phone:385-405-5790
Mailing Address - Fax:
Practice Address - Street 1:1513 N HILL FIELD RD STE 1-002
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2162
Practice Address - Country:US
Practice Address - Phone:801-675-8583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)