Provider Demographics
NPI:1962087635
Name:DR. CHRISTY KANE LLC
Entity type:Organization
Organization Name:DR. CHRISTY KANE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:PECK
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-735-5971
Mailing Address - Street 1:9722 N 5650 W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3533
Mailing Address - Country:US
Mailing Address - Phone:801-735-5971
Mailing Address - Fax:
Practice Address - Street 1:5455 W 11000 N STE 204
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8802
Practice Address - Country:US
Practice Address - Phone:801-735-5971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5716781-6004OtherCMHC