Provider Demographics
NPI:1447064852
Name:START THERAPY SPECIALIZED TRAUMA AND RECOVERY TREATMENT PLLC
Entity type:Organization
Organization Name:START THERAPY SPECIALIZED TRAUMA AND RECOVERY TREATMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLPACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-888-4657
Mailing Address - Street 1:1127 N 2825 W
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3400
Mailing Address - Country:US
Mailing Address - Phone:801-609-5515
Mailing Address - Fax:
Practice Address - Street 1:780 S 2000 W STE A101
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9612
Practice Address - Country:US
Practice Address - Phone:801-609-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty