Provider Demographics
NPI:1154916823
Name:MODERN EVE INC
Entity type:Organization
Organization Name:MODERN EVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-695-9955
Mailing Address - Street 1:323 E STANTON AVE # A
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3519
Mailing Address - Country:US
Mailing Address - Phone:801-695-9955
Mailing Address - Fax:
Practice Address - Street 1:323 E STANTON AVE # A
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84111-3519
Practice Address - Country:US
Practice Address - Phone:801-695-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty