Provider Demographics
NPI:1013263524
Name:LATTER DAY SAINTS FAMILY SERVICES
Entity Type:Organization
Organization Name:LATTER DAY SAINTS FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSW/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:TABAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:801-489-9721
Mailing Address - Street 1:1672 W 700 S STE D
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-4963
Mailing Address - Country:US
Mailing Address - Phone:801-489-9721
Mailing Address - Fax:
Practice Address - Street 1:1672 W 700 S STE D
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4963
Practice Address - Country:US
Practice Address - Phone:801-489-9721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7946204-3502251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health