Provider Demographics
NPI:1154614964
Name:ASSESSMENT, COUNSELING, & EDUCATIONAL SERVICES
Entity type:Organization
Organization Name:ASSESSMENT, COUNSELING, & EDUCATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR, THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-265-8000
Mailing Address - Street 1:2970 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-6034
Mailing Address - Country:US
Mailing Address - Phone:801-265-8000
Mailing Address - Fax:801-265-8004
Practice Address - Street 1:2970 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-6034
Practice Address - Country:US
Practice Address - Phone:801-265-8000
Practice Address - Fax:801-265-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6613419-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty