Provider Demographics
NPI:1083039184
Name:NAMASTE CENTER FOR HEALING
Entity type:Organization
Organization Name:NAMASTE CENTER FOR HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-272-3500
Mailing Address - Street 1:4505 S WASATCH BLVD
Mailing Address - Street 2:SUITE #340
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4709
Mailing Address - Country:US
Mailing Address - Phone:801-272-3500
Mailing Address - Fax:801-272-3355
Practice Address - Street 1:4505 S WASATCH BLVD
Practice Address - Street 2:SUITE #340
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4709
Practice Address - Country:US
Practice Address - Phone:801-272-3500
Practice Address - Fax:801-272-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360959-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty