Provider Demographics
NPI:1184127144
Name:KMK FAMILY SERVICES, INC
Entity type:Organization
Organization Name:KMK FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALOUDIS
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-201-7050
Mailing Address - Street 1:PO BOX 17864
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-0864
Mailing Address - Country:US
Mailing Address - Phone:801-201-7050
Mailing Address - Fax:801-274-0411
Practice Address - Street 1:5620 S WATERBURY WAY STE A206
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6206
Practice Address - Country:US
Practice Address - Phone:801-201-7050
Practice Address - Fax:801-274-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6521299-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty