Provider Demographics
NPI:1154889236
Name:TRAUMA FOCUSED RECOVERY PLLC
Entity type:Organization
Organization Name:TRAUMA FOCUSED RECOVERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-821-4578
Mailing Address - Street 1:4007 IVY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GREEN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-6705
Mailing Address - Country:US
Mailing Address - Phone:801-821-4578
Mailing Address - Fax:801-906-2169
Practice Address - Street 1:5974 FASHION POINT DR STE 250
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4841
Practice Address - Country:US
Practice Address - Phone:801-821-4578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty