| Lds Family Services Ut Salt Lake City Agency | |
|
132 S State St Ste 100 Salt Lake City UT 84111-1506 | |
| (801) 240-6500 | |
| (801) 240-5508 |
| Full Name | Lds Family Services Ut Salt Lake City Agency |
|---|---|
| Speciality | Clinic/Center |
| Location | 132 S State St Ste 100, Salt Lake City, Utah |
| Authorized Official Name and Position | Kevin C Sherman (DIRECTOR) |
| Authorized Official Contact | 8012406500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lds Family Services Ut Salt Lake City Agency 132 S State St Ste 100 Salt Lake City UT 84111-1506 Ph: (801) 240-6500 | Lds Family Services Ut Salt Lake City Agency 132 S State St Ste 100 Salt Lake City UT 84111-1506 Ph: (801) 240-6500 |
| NPI Number | 1760576698 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 06/06/2008 |
| Medicare PECOS PAC ID | 4385621002 |
|---|---|
| Medicare Enrollment ID | O20040701000243 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760576698 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Stacy S Heaps |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063553667 PECOS PAC ID: 0143446476 Enrollment ID: I20140723000719 |
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