Healthcare Provider Details

I. General information

NPI: 1720120249
Provider Name (Legal Business Name): THE SALT LAKE MARITAL AND FAMILY THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 S 700 E SUITE #11
SALT LAKE CITY UT
84105-2149
US

IV. Provider business mailing address

1399 S 700 E SUITE #11
SALT LAKE CITY UT
84105-2149
US

V. Phone/Fax

Practice location:
  • Phone: 801-521-5068
  • Fax: 801-521-7021
Mailing address:
  • Phone: 801-521-5068
  • Fax: 801-521-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126354-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARGARET L THOMPSON
Title or Position: DIRECTOR
Credential: MSW
Phone: 801-521-5068