Provider Demographics
NPI:1578967642
Name:SALT LAKE MARITAL & FAMILY THERAPY CLINIC
Entity Type:Organization
Organization Name:SALT LAKE MARITAL & FAMILY THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-521-5068
Mailing Address - Street 1:420 E SOUTH TEMPLE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1319
Mailing Address - Country:US
Mailing Address - Phone:801-521-5068
Mailing Address - Fax:801-521-7021
Practice Address - Street 1:420 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1319
Practice Address - Country:US
Practice Address - Phone:801-521-5068
Practice Address - Fax:801-521-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8319884-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty