Provider Demographics
NPI:1386486736
Name:COTTONWOOD MOVEMENT THERAPY
Entity type:Organization
Organization Name:COTTONWOOD MOVEMENT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YURICK
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-610-6801
Mailing Address - Street 1:PO BOX 712372
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84171-2372
Mailing Address - Country:US
Mailing Address - Phone:801-610-6801
Mailing Address - Fax:
Practice Address - Street 1:925 E EXECUTIVE PARK DR STE B
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-3545
Practice Address - Country:US
Practice Address - Phone:801-610-6801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty