Provider Demographics
NPI:1568784585
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES UT RIVERTON OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERILYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-254-9976
Mailing Address - Street 1:3740 MARKET CENTER DR
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-8026
Mailing Address - Country:US
Mailing Address - Phone:801-254-9976
Mailing Address - Fax:
Practice Address - Street 1:3740 MARKET CENTER DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-8026
Practice Address - Country:US
Practice Address - Phone:801-254-9976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health