Healthcare Provider Details

I. General information

NPI: 1558395525
Provider Name (Legal Business Name): SHEPHERDS STAFF CHRISTIAN COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 E FORT UNION BLVD STE 201
MIDVALE UT
84047-5543
US

IV. Provider business mailing address

193 E FORT UNION BLVD STE 201
MIDVALE UT
84047-5543
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-1564
  • Fax: 801-268-1565
Mailing address:
  • Phone: 801-268-1564
  • Fax: 801-268-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FREDERICK PRAMANN
Title or Position: BOARD MEMBER AND CLINICAL DIRECTOR
Credential: PH.D.
Phone: 801-268-1564