Provider Demographics
NPI:1346559382
Name:CHILDREN SERVICE SOCIETY OF UTAH
Entity Type:Organization
Organization Name:CHILDREN SERVICE SOCIETY OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:801-326-4368
Mailing Address - Street 1:124 S 400 E
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2135
Mailing Address - Country:US
Mailing Address - Phone:801-355-7444
Mailing Address - Fax:801-355-7453
Practice Address - Street 1:124 S 400 E
Practice Address - Street 2:SUITE 400
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2135
Practice Address - Country:US
Practice Address - Phone:801-355-7444
Practice Address - Fax:801-355-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health