Provider Demographics
NPI:1154172468
Name:EB PSYCHOTHERAPY
Entity type:Organization
Organization Name:EB PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELYCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC
Authorized Official - Phone:530-227-7468
Mailing Address - Street 1:782 E PIONEER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5751
Mailing Address - Country:US
Mailing Address - Phone:530-227-7468
Mailing Address - Fax:
Practice Address - Street 1:782 E PIONEER RD STE 200
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5751
Practice Address - Country:US
Practice Address - Phone:530-227-7468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)