Provider Demographics
NPI:1609319888
Name:ACHIEVE FAMILY THERAPY
Entity Type:Organization
Organization Name:ACHIEVE FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOSKO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, CEFT
Authorized Official - Phone:801-890-5151
Mailing Address - Street 1:11075 S STATE ST
Mailing Address - Street 2:UNIT 3, SUITE 102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5164
Mailing Address - Country:US
Mailing Address - Phone:801-890-5151
Mailing Address - Fax:801-890-5152
Practice Address - Street 1:11075 S STATE ST
Practice Address - Street 2:UNIT 3, SUITE 102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5164
Practice Address - Country:US
Practice Address - Phone:801-890-5151
Practice Address - Fax:801-890-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT87730083902261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health