Provider Demographics
NPI:1700012192
Name:CENTER FOR INDIVIDUAL RESPONSIBILITY
Entity Type:Organization
Organization Name:CENTER FOR INDIVIDUAL RESPONSIBILITY
Other - Org Name:CIRCLE TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-680-4705
Mailing Address - Street 1:432 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1510
Mailing Address - Country:US
Mailing Address - Phone:435-841-9177
Mailing Address - Fax:435-882-7330
Practice Address - Street 1:312 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2746
Practice Address - Country:US
Practice Address - Phone:435-841-9177
Practice Address - Fax:435-882-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-31
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT33328535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty