Provider Demographics
NPI:1316412166
Name:CARALEE CHILD, LCSW, PLLC
Entity Type:Organization
Organization Name:CARALEE CHILD, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-589-4965
Mailing Address - Street 1:2792 N 4975 E
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84310-9800
Mailing Address - Country:US
Mailing Address - Phone:801-589-4965
Mailing Address - Fax:801-447-9578
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3195
Practice Address - Country:US
Practice Address - Phone:801-589-4965
Practice Address - Fax:801-447-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)