Provider Demographics
NPI:1720806474
Name:TRADEMARK THERAPY A PROFESSIONAL LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:TRADEMARK THERAPY A PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN SIGNE
Authorized Official - Last Name:ABLAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-580-5689
Mailing Address - Street 1:665 E WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3007
Mailing Address - Country:US
Mailing Address - Phone:801-580-5689
Mailing Address - Fax:
Practice Address - Street 1:2150 S 1300 E STE 500
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-4375
Practice Address - Country:US
Practice Address - Phone:801-609-4524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty