| Lds Family Services Ut Provo Agency | |
|
1190 N 900 E 204 Provo UT 84604-3536 | |
| (801) 422-7620 | |
| (801) 422-0165 |
| Full Name | Lds Family Services Ut Provo Agency |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1190 N 900 E, Provo, Utah |
| Authorized Official Name and Position | Shawn A Gillies (AGENCY DIRECTOR) |
| Authorized Official Contact | 8014227620 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lds Family Services Ut Provo Agency 1190 N 900 E 204 Provo UT 84604-3536 Ph: (801) 422-7620 | Lds Family Services Ut Provo Agency 1190 N 900 E 204 Provo UT 84604-3536 Ph: (801) 422-7620 |
| NPI Number | 1669691499 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 06/06/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669691499 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 12208 (Utah) | Primary |
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