Healthcare Provider Details

I. General information

NPI: 1609319888
Provider Name (Legal Business Name): ACHIEVE FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11075 S STATE ST UNIT 3, SUITE 102
SANDY UT
84070-5164
US

IV. Provider business mailing address

11075 S STATE ST UNIT 3, SUITE 102
SANDY UT
84070-5164
US

V. Phone/Fax

Practice location:
  • Phone: 801-890-5151
  • Fax: 801-890-5152
Mailing address:
  • Phone: 801-890-5151
  • Fax: 801-890-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number87730083902
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number87730083902
License Number StateUT

VIII. Authorized Official

Name: MRS. JENNIFER SOLOSKO
Title or Position: OWNER/MARRIAGE AND FAMILY THERAPIST
Credential: M.A., LMFT, CEFT
Phone: 801-890-5151