Healthcare Provider Details

I. General information

NPI: 1679330070
Provider Name (Legal Business Name): GOGIVERS FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 E PARLEYS WAY STE 220
SALT LAKE CITY UT
84109-1252
US

IV. Provider business mailing address

2455 E PARLEYS WAY STE 220
SALT LAKE CITY UT
84109-1252
US

V. Phone/Fax

Practice location:
  • Phone: 801-403-0033
  • Fax:
Mailing address:
  • Phone: 801-403-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ELENOA MOALA
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 801-403-0033