Provider Demographics
NPI:1346954575
Name:AFFINITY FAMILY COUNSELING
Entity Type:Organization
Organization Name:AFFINITY FAMILY COUNSELING
Other - Org Name:AFFINITY FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMPUERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-735-2536
Mailing Address - Street 1:870 E 9400 S STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3677
Mailing Address - Country:US
Mailing Address - Phone:801-252-5036
Mailing Address - Fax:
Practice Address - Street 1:7430 S CREEK RD STE 104
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6160
Practice Address - Country:US
Practice Address - Phone:801-252-5036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty