Provider Demographics
NPI:1558395525
Name:SHEPHERDS STAFF CHRISTIAN COUNSELING CENTER INC
Entity Type:Organization
Organization Name:SHEPHERDS STAFF CHRISTIAN COUNSELING CENTER INC
Other - Org Name:CHRISTIAN COUNSELING CENTERS OF UTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER AND CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:PRAMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-268-1564
Mailing Address - Street 1:404 E 4500 S STE B22
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2776
Mailing Address - Country:US
Mailing Address - Phone:801-268-1564
Mailing Address - Fax:801-268-1565
Practice Address - Street 1:404 E 4500 S STE B22
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-2776
Practice Address - Country:US
Practice Address - Phone:801-268-1564
Practice Address - Fax:801-268-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT798632OtherUUHP
UTX07041Medicare UPIN
UT000055377Medicare PIN