Provider Demographics
NPI:1336012806
Name:BIG VALLEY THERAPY LLC
Entity type:Organization
Organization Name:BIG VALLEY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:KEI
Authorized Official - Last Name:OTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:408-334-8642
Mailing Address - Street 1:4936 W MIMOSA ST
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6327
Mailing Address - Country:US
Mailing Address - Phone:408-334-8642
Mailing Address - Fax:
Practice Address - Street 1:4936 W MIMOSA ST
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6327
Practice Address - Country:US
Practice Address - Phone:408-334-8642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty