MEDICARE: LDS FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1760576698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDS FAMILY SERVICES

Provider Business Mailing Address
First Line	:	132 S STATE ST STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1506
Country	:	US
Telephone Number	:	801-240-6500
Fax Number	:	801-240-5508

Provider Business Practice Location Address
First Line	:	132 S STATE ST STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1506
Country	:	US
Telephone Number	:	801-240-6500
Fax Number	:	801-240-5508

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KEVIN C SHERMAN
Credential	:
Telephone Number	:	801-240-6500

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	06/06/2008

Similar Medicare Providers

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Practice Location Address:

132 S STATE ST , SUITE 100
SALT LAKE CITY, UT
84111-1506

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1134217250 — MRS. NANCY LEE BICE LPC
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1235229741 — KEVIN THERIOT PH.D.
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1184705303 — MR. SHAWN JAMES EVANS L.C.S.W.
Practice Location Address:

132 S STATE ST , SUITE 200
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84111-1506

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1659452936 — WENDI ANN DUNFORD CSW
Practice Location Address:

132 S STATE ST STE 100
SALT LAKE CITY, UT
84111-1506

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1982774832 — MR. MARTIN THOMAS O DONNELL JR. LCSW
Practice Location Address:

132 SOUTH STATE STREET , SUITE 100
SALT LAKE CITY, UT
84111-1506

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Practice Fax: 801-240-5508

Directions to “LDS FAMILY SERVICES ” Practice Location

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