Provider Demographics
NPI:1922507821
Name:SOUTHERN UTAH FAMILY COUNSELING
Entity Type:Organization
Organization Name:SOUTHERN UTAH FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-528-4000
Mailing Address - Street 1:321 N MALL DR STE B201
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7310
Mailing Address - Country:US
Mailing Address - Phone:435-319-0236
Mailing Address - Fax:833-801-1088
Practice Address - Street 1:321 N MALL DR STE B201
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7310
Practice Address - Country:US
Practice Address - Phone:435-319-0236
Practice Address - Fax:833-801-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7738832-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty