Healthcare Provider Details

I. General information

NPI: 1730022443
Provider Name (Legal Business Name): FAMILI IOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 KEYRIDGE CIR
OREM UT
84058-7681
US

IV. Provider business mailing address

191 KEYRIDGE CIR
OREM UT
84058-7681
US

V. Phone/Fax

Practice location:
  • Phone: 801-830-7725
  • Fax:
Mailing address:
  • Phone: 801-830-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: GLENN S HAVEA
Title or Position: CEO
Credential:
Phone: 801-830-7725