Provider Demographics
NPI:1790053395
Name:LATTER DAY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LATTER DAY COUNSELING SERVICES, LLC
Other - Org Name:LATTER DAY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-312-0312
Mailing Address - Street 1:1324 S 175 E
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-3702
Mailing Address - Country:US
Mailing Address - Phone:801-312-0312
Mailing Address - Fax:
Practice Address - Street 1:1438 N HIGHWAY 89
Practice Address - Street 2:SUITE 130
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2737
Practice Address - Country:US
Practice Address - Phone:801-312-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty