Provider Demographics
NPI:1689568362
Name:REAL TALK LLC
Entity type:Organization
Organization Name:REAL TALK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FREED
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-640-7516
Mailing Address - Street 1:50 W BROADWAY STE 333
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2027
Mailing Address - Country:US
Mailing Address - Phone:801-382-9593
Mailing Address - Fax:
Practice Address - Street 1:812 E 4800 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5034
Practice Address - Country:US
Practice Address - Phone:801-382-9593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1235718230Medicaid