Provider Demographics
NPI:1659677219
Name:AMPUERO, FRANCISCO XAVIER (LA-SUDC; LCSW)
Entity Type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:XAVIER
Last Name:AMPUERO
Suffix:
Gender:M
Credentials:LA-SUDC; LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 SO. SLATE CANYON DR.
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606
Mailing Address - Country:US
Mailing Address - Phone:801-691-0880
Mailing Address - Fax:
Practice Address - Street 1:277 E 950 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5004
Practice Address - Country:US
Practice Address - Phone:801-691-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
UT4953588-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health