| Moonbridge Therapy Llc | |
|
503 W 2600 S Suite 200, A Bountiful UT 84010 | |
| (801) 251-6431 | |
| Not Available |
| Full Name | Moonbridge Therapy Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 503 W 2600 S Suite 200, A, Bountiful, Utah |
| Authorized Official Name and Position | Mike Kaare Klitgaard (OWNER) |
| Authorized Official Contact | 8012516431 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moonbridge Therapy Llc Po Box 540032 North Salt Lake UT 84054-0032 Ph: (801) 251-6431 | Moonbridge Therapy Llc 503 W 2600 S Suite 200, A Bountiful UT 84010 Ph: (801) 251-6431 |
| NPI Number | 1679395362 |
|---|---|
| Provider Enumeration Date | 10/25/2024 |
| Last Update Date | 10/25/2024 |
| Certification Date | 10/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679395362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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