Provider Demographics
NPI:1376636332
Name:VASSAR, RICHARD EVANS JR (LMFT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EVANS
Last Name:VASSAR
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11813 MAPLE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-7332
Mailing Address - Country:US
Mailing Address - Phone:801-558-2582
Mailing Address - Fax:801-501-7317
Practice Address - Street 1:11075 S STATE ST
Practice Address - Street 2:SUITE 28
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5164
Practice Address - Country:US
Practice Address - Phone:801-501-8444
Practice Address - Fax:801-501-7317
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT331404-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist