Provider Demographics
NPI:1699154047
Name:FAMILY COUNSELING CENTER
Entity type:Organization
Organization Name:FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LODEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:180-126-3500
Mailing Address - Street 1:5250 S COMMERCE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7926
Mailing Address - Country:US
Mailing Address - Phone:801-261-3500
Mailing Address - Fax:801-261-2111
Practice Address - Street 1:5250 S COMMERCE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7926
Practice Address - Country:US
Practice Address - Phone:801-261-3500
Practice Address - Fax:801-261-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health