Provider Demographics
NPI:1710616503
Name:EMDR AND COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:EMDR AND COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-507-0166
Mailing Address - Street 1:6975 S UNION PARK AVENUE SUITE 600
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4187
Mailing Address - Country:US
Mailing Address - Phone:385-231-1680
Mailing Address - Fax:
Practice Address - Street 1:6975 S UNION PARK AVENUE SUITE 600
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84047-8404
Practice Address - Country:US
Practice Address - Phone:385-231-1680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty