Provider Demographics
NPI:1871845685
Name:MAXIMUM POTENTIAL
Entity type:Organization
Organization Name:MAXIMUM POTENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT PHD
Authorized Official - Phone:801-330-3651
Mailing Address - Street 1:9067 S 1300 W STE 204
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5582
Mailing Address - Country:US
Mailing Address - Phone:801-748-2192
Mailing Address - Fax:385-234-4822
Practice Address - Street 1:9067 S 1300 W STE 204
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5582
Practice Address - Country:US
Practice Address - Phone:801-748-2192
Practice Address - Fax:385-234-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT293367-6004101YP2500X
UT11209--3902106H00000X
UT6972251-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty