Provider Demographics
NPI:1285922088
Name:BOX ELDER FAMILY SUPPORT CENTER
Entity type:Organization
Organization Name:BOX ELDER FAMILY SUPPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-723-6010
Mailing Address - Street 1:276 N 200 E
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2137
Mailing Address - Country:US
Mailing Address - Phone:435-723-6010
Mailing Address - Fax:435-723-7539
Practice Address - Street 1:276 N 200 E
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2137
Practice Address - Country:US
Practice Address - Phone:435-723-6010
Practice Address - Fax:435-723-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT18217251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health