Provider Demographics
NPI:1760104798
Name:SPRINGVILLE FAMILY COUNSELING SERVICES
Entity Type:Organization
Organization Name:SPRINGVILLE FAMILY COUNSELING SERVICES
Other - Org Name:BROOKSIDE FAMILY COUNSELING ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-400-5034
Mailing Address - Street 1:1220 N MAIN ST STE 11
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-4016
Mailing Address - Country:US
Mailing Address - Phone:801-400-5034
Mailing Address - Fax:801-373-4451
Practice Address - Street 1:1220 N MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4016
Practice Address - Country:US
Practice Address - Phone:801-400-5034
Practice Address - Fax:801-373-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty