Healthcare Provider Details

I. General information

NPI: 1083704597
Provider Name (Legal Business Name): FAMILY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 EAST 4500 SOUTH SUITE 300
MURRAY UT
84107-2900
US

IV. Provider business mailing address

650 EAST 4500 SOUTH SUITE 300
MURRAY UT
84107-2900
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-3500
  • Fax: 801-261-2111
Mailing address:
  • Phone: 801-261-3500
  • Fax: 801-261-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number11651
License Number StateUT

VIII. Authorized Official

Name: MS. VICKY WESTMORELAND
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: LASUDC, CMHC, EDDCP
Phone: 801-261-3500