Healthcare Provider Details

I. General information

NPI: 1851233282
Provider Name (Legal Business Name): A CHILD'S PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4568 S HIGHLAND DR STE 100
SALT LAKE CITY UT
84117-4234
US

IV. Provider business mailing address

4568 S HIGHLAND DR STE 100
SALT LAKE CITY UT
84117-4234
US

V. Phone/Fax

Practice location:
  • Phone: 801-232-5363
  • Fax:
Mailing address:
  • Phone: 801-232-5363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CARLA JEAN REYES
Title or Position: OWNER/PSYCHOLOIGST
Credential: PH.D.
Phone: 801-232-5363