Provider Demographics
NPI:1316419021
Name:BEAR'S EARS CHILD AND FAMILY THERAPY LLC
Entity type:Organization
Organization Name:BEAR'S EARS CHILD AND FAMILY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:WESTOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:435-882-4354
Mailing Address - Street 1:22 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2035
Mailing Address - Country:US
Mailing Address - Phone:435-882-4354
Mailing Address - Fax:
Practice Address - Street 1:22 W VINE ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2035
Practice Address - Country:US
Practice Address - Phone:435-882-4354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)