Provider Demographics
NPI:1114417219
Name:UTAH CENTER FOR COUPLES AND FAMILIES, PLLC
Entity Type:Organization
Organization Name:UTAH CENTER FOR COUPLES AND FAMILIES, PLLC
Other - Org Name:HOLLADAY CENTER FOR COUPLES AND FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:SCOVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFT
Authorized Official - Phone:801-709-1785
Mailing Address - Street 1:3507 N UNIVERSITY AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6602
Mailing Address - Country:US
Mailing Address - Phone:385-429-0380
Mailing Address - Fax:
Practice Address - Street 1:4190 S HIGHLAND DR STE 104
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2661
Practice Address - Country:US
Practice Address - Phone:385-429-0380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6370628-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty