Provider Demographics
NPI:1992835680
Name:MACFARLANE, JOHN RICHARD SR (LCSW MFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:MACFARLANE
Suffix:SR
Gender:M
Credentials:LCSW MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 E SOUTH TEMPLE APT 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1360
Mailing Address - Country:US
Mailing Address - Phone:801-712-1109
Mailing Address - Fax:
Practice Address - Street 1:508 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 201
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:801-328-8817
Practice Address - Fax:801-366-4284
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1005923902106H00000X
UT10059235011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist