Provider Demographics
NPI:1326604125
Name:MESSICK FAMILY COUNSELING LLC.
Entity Type:Organization
Organization Name:MESSICK FAMILY COUNSELING LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-241-4920
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-0425
Mailing Address - Country:US
Mailing Address - Phone:435-241-4920
Mailing Address - Fax:
Practice Address - Street 1:66 W VINE ST # 1
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2185
Practice Address - Country:US
Practice Address - Phone:435-241-4920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1902130123OtherNPI