NPIMap

Organization Active NPI

Moonbridge Therapy LLC

  • Mental Health Counselor
  • Bountiful, UT
National Provider Identifier
1679395362
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MOONBRIDGE THERAPY LLC
Practice address
503 W 2600 S Suite 200, a
Bountiful, UT 84010
Phone
(801) 251-6431
NPI assigned
Oct 25, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mike Kaare Klitgaard, LCMHCNPI 1174215800
Title
Owner
Phone
(801) 251-6431

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

503 W 2600 S Suite 200, a
Bountiful, UT 84010

Mailing address

PO Box 540032
North Salt Lake, UT 84054-0032
Phone (801) 251-6431

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1679395362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 540032",
            "city": "NORTH SALT LAKE",
            "state": "UT",
            "postal_code": "840540032",
            "telephone_number": "801-251-6431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 W 2600 S SUITE 200, A",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "84010",
            "telephone_number": "801-251-6431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONBRIDGE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "KLITGAARD",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "KAARE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-251-6431",
        "authorized_official_credential": "LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.