Provider Demographics
NPI:1760788285
Name:FAMILY SUPPORT CENTER OF OGDEN, INC.
Entity Type:Organization
Organization Name:FAMILY SUPPORT CENTER OF OGDEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFCC
Authorized Official - Phone:801-393-3113
Mailing Address - Street 1:3340 HARRISON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1200
Mailing Address - Country:US
Mailing Address - Phone:801-393-3113
Mailing Address - Fax:801-394-1910
Practice Address - Street 1:3340 HARRISON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1200
Practice Address - Country:US
Practice Address - Phone:801-393-3113
Practice Address - Fax:801-394-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17491251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health