Provider Demographics
NPI:1619025947
Name:PENELOPE EICHER MFT INC
Entity Type:Organization
Organization Name:PENELOPE EICHER MFT INC
Other - Org Name:LIFE CHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF LLC MARRIAGE & FAMILY
Authorized Official - Prefix:MS
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:435-673-1483
Mailing Address - Street 1:437 S BLUFF ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-673-1483
Mailing Address - Fax:435-674-9380
Practice Address - Street 1:437 S BLUFF ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-673-1483
Practice Address - Fax:435-674-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116677-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty