Healthcare Provider Details

I. General information

NPI: 1790726156
Provider Name (Legal Business Name): LDS FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 S 500 E
AMERICAN FORK UT
84003-2527
US

IV. Provider business mailing address

433 S 500 E
AMERICAN FORK UT
84003-2527
US

V. Phone/Fax

Practice location:
  • Phone: 801-216-8000
  • Fax: 801-216-8001
Mailing address:
  • Phone: 801-216-8000
  • Fax: 801-216-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number100903
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10903
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10903
License Number StateUT

VIII. Authorized Official

Name: MRS. STEPHANIE MINER
Title or Position: AGENCY DIRECTOR
Credential: LCSW
Phone: 801-216-8000