Provider Demographics
NPI:1689853251
Name:WASATCH FAMILY THERAPY, LLC
Entity Type:Organization
Organization Name:WASATCH FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-944-4555
Mailing Address - Street 1:7084 S 2300 E
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3968
Mailing Address - Country:US
Mailing Address - Phone:801-550-2741
Mailing Address - Fax:
Practice Address - Street 1:7084 S 2300 E
Practice Address - Street 2:SUITE 120
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3968
Practice Address - Country:US
Practice Address - Phone:801-550-2741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT33310335011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty