Provider Demographics
NPI:1417299827
Name:NORTHERN UTAH CENTER FOR COUPLES AND FAMILIES, PLLC
Entity Type:Organization
Organization Name:NORTHERN UTAH CENTER FOR COUPLES AND FAMILIES, PLLC
Other - Org Name:PROVO CENTER FOR COUPLES AND FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:SCOVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:801-709-1785
Mailing Address - Street 1:1426 E 820 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-5481
Mailing Address - Country:US
Mailing Address - Phone:801-477-0041
Mailing Address - Fax:
Practice Address - Street 1:1426 E 820 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-5481
Practice Address - Country:US
Practice Address - Phone:801-477-0041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-23
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8620286-0162261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center