Provider Demographics
NPI:1588740773
Name:AMSDEN, SALLY MARGARET (LMFT)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:MARGARET
Last Name:AMSDEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255E 3900S
Mailing Address - Street 2:STE 107
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-635-7933
Mailing Address - Fax:301-266-7436
Practice Address - Street 1:1255E 3900S
Practice Address - Street 2:STE 107
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-635-7933
Practice Address - Fax:301-266-7436
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT379034-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist