# FUNCTIONALLY INTEGRATIVE THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184503492
- **Authorized official:** STEVEN ROTH LCSW (OWNER/THERAPIST)
- **Authorized official phone:** (385) 208-6197

## Contact information

- **Practice address:** 5620 S WATERBURY WAY, SALT LAKE CITY, UT 84121-1180
- **Practice address phone:** (385) 208-6197
- **Mailing address:** PO BOX 18182, KEARNS, UT 84118-0182
- **Mailing address phone:** (385) 208-6197

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/29/2025
- **Last updated:** 08/29/2025