Healthcare Provider Details

I. General information

NPI: 1912371378
Provider Name (Legal Business Name): FOUNDATION FOR FAMILY LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date: 10/24/2019
Reactivation Date: 12/20/2019

III. Provider practice location address

11978 S REDWOOD RD
RIVERTON UT
84065-7403
US

IV. Provider business mailing address

1875 W 12600 S # 230
RIVERTON UT
84065-7044
US

V. Phone/Fax

Practice location:
  • Phone: 801-750-5398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH WHITE
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 801-750-5398