Provider Demographics
NPI:1235656729
Name:FAMILY & RELATIONSHIP WELLNESS THERAPY
Entity Type:Organization
Organization Name:FAMILY & RELATIONSHIP WELLNESS THERAPY
Other - Org Name:JUSTIN GORDON, LMFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:435-215-3184
Mailing Address - Street 1:336 W 3162 S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8352
Mailing Address - Country:US
Mailing Address - Phone:435-215-3184
Mailing Address - Fax:
Practice Address - Street 1:1031 S BLUFF ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5206
Practice Address - Country:US
Practice Address - Phone:435-215-3184
Practice Address - Fax:435-634-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
UT8017789-3902261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)