Provider Demographics
NPI:1780014019
Name:FAMILY COUNSELING SERVICE OF NORTHERN UTAH INC
Entity Type:Organization
Organization Name:FAMILY COUNSELING SERVICE OF NORTHERN UTAH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BYRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-399-1600
Mailing Address - Street 1:3518 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1034
Mailing Address - Country:US
Mailing Address - Phone:801-399-1600
Mailing Address - Fax:801-399-1640
Practice Address - Street 1:3518 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1034
Practice Address - Country:US
Practice Address - Phone:801-399-1600
Practice Address - Fax:801-399-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49619423501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty