Provider Demographics
NPI:1306029921
Name:INTENTIONAL FAMILY INSTITUTE
Entity Type:Organization
Organization Name:INTENTIONAL FAMILY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VILLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MS , LMFT
Authorized Official - Phone:801-352-2000
Mailing Address - Street 1:9160 S 300 W
Mailing Address - Street 2:SUITE 21
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2655
Mailing Address - Country:US
Mailing Address - Phone:801-352-2000
Mailing Address - Fax:
Practice Address - Street 1:9160 S OUTH 300 WEST
Practice Address - Street 2:SUITE 21
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2655
Practice Address - Country:US
Practice Address - Phone:801-352-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59432763902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty