Provider Demographics
NPI:1801344726
Name:CHILDREN'S SERVICE SOCIETY
Entity type:Organization
Organization Name:CHILDREN'S SERVICE SOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENCARNI
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:801-326-4380
Mailing Address - Street 1:655 E 4500 S STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2969
Mailing Address - Country:US
Mailing Address - Phone:801-326-4380
Mailing Address - Fax:801-355-7453
Practice Address - Street 1:655 E 4500 S STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2969
Practice Address - Country:US
Practice Address - Phone:801-326-4380
Practice Address - Fax:801-355-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT27689251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health