Healthcare Provider Details

I. General information

NPI: 1023425931
Provider Name (Legal Business Name): SEQUOIA FAMILY THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 S 700 E STE 230
SANDY UT
84070-0570
US

IV. Provider business mailing address

1913 S 1200 W
SYRACUSE UT
84075-8812
US

V. Phone/Fax

Practice location:
  • Phone: 385-244-6927
  • Fax:
Mailing address:
  • Phone: 385-244-6927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number8449538-3904
License Number StateUT

VIII. Authorized Official

Name: JOHN DARRIS ELLIS
Title or Position: OWNER/THERAPIST
Credential: LMFT
Phone: 385-244-6927