Provider Demographics
NPI:1346354875
Name:FAMILY DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:FAMILY DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-748-2270
Mailing Address - Street 1:8817 REDWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9266
Mailing Address - Country:US
Mailing Address - Phone:801-748-2270
Mailing Address - Fax:801-748-2271
Practice Address - Street 1:8817 REDWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9266
Practice Address - Country:US
Practice Address - Phone:801-748-2270
Practice Address - Fax:801-748-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108286-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52954286702001OtherBCBS OF UTAH