Healthcare Provider Details

I. General information

NPI: 1568784585
Provider Name (Legal Business Name): LDS FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 MARKET CENTER DR SUITE 1200
RIVERTON UT
84065-8026
US

IV. Provider business mailing address

3740 MARKET CENTER DR SUITE 1200
RIVERTON UT
84065-8026
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-9976
  • Fax:
Mailing address:
  • Phone: 801-254-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERILYN C STINSON
Title or Position: CLINICAL MANAGER
Credential: LCSW
Phone: 801-254-9976