| Evidence Based Treatment Centers Of Salt Lake City, Pllc | |
|
2225 E Murray Holladay Rd Ste 116 Holladay UT 84117-5382 | |
| (206) 374-0109 | |
| (206) 374-0108 |
| Full Name | Evidence Based Treatment Centers Of Salt Lake City, Pllc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2225 E Murray Holladay Rd Ste 116, Holladay, Utah |
| Authorized Official Name and Position | Adrienne C Bennett (CLINIC COORDINATOR) |
| Authorized Official Contact | 4253619272 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evidence Based Treatment Centers Of Salt Lake City, Pllc 1200 5th Ave Ste 800 Seattle WA 98101-3136 Ph: (206) 374-0101 | Evidence Based Treatment Centers Of Salt Lake City, Pllc 2225 E Murray Holladay Rd Ste 116 Holladay UT 84117-5382 Ph: (206) 374-0109 |
| NPI Number | 1326783689 |
|---|---|
| Provider Enumeration Date | 05/02/2022 |
| Last Update Date | 02/02/2023 |
| Certification Date | 02/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326783689 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (* (Not Available)) | Secondary |
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