Provider Demographics
NPI:1821303595
Name:FACER, STEVEN JEREMEY
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JEREMEY
Last Name:FACER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 S REDWOOD RD
Mailing Address - Street 2:APT 2094
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-6530
Mailing Address - Country:US
Mailing Address - Phone:801-707-0182
Mailing Address - Fax:
Practice Address - Street 1:5930 S 4800 W
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-6061
Practice Address - Country:US
Practice Address - Phone:801-966-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children