Provider Demographics
NPI:1013470590
Name:FAMILY THERAPY CENTER OF UTAH, LLC
Entity Type:Organization
Organization Name:FAMILY THERAPY CENTER OF UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:385-243-0012
Mailing Address - Street 1:240 N EAST PROMONTORY STE 234
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2950
Mailing Address - Country:US
Mailing Address - Phone:385-243-0012
Mailing Address - Fax:
Practice Address - Street 1:240 N EAST PROMONTORY STE 234
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2950
Practice Address - Country:US
Practice Address - Phone:385-243-0012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty