Organization
CREATING CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN PARKER LCSW (THERAPIST)
(801) 671-1315
Entity
Organization
Contact information
Practice address
3098 HIGHLAND DR STE 369, SALT LAKE CITY, UT 84106-6007
(801) 671-1315
Mailing address
PO BOX 1503, SANDY, UT 84091-1503
(801) 671-1315
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
68850903501
UT
Other
Enumeration date
07/30/2010
Last updated
03/15/2012
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