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General NPI Number Information
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NPI Number | 1558395525
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Entity Type | Organization
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Legal Business Name | SHEPHERDS STAFF CHRISTIAN COUNSELING CENTER INC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 404 E 4500 S STE B22
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City | MURRAY
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State | UT
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Zip | 84107-2776
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Country | US
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Telephone | 801-268-1564
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Fax | 801-268-1565
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Provider Business Mailing Address
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Address Line | 404 E 4500 S STE B22
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City | MURRAY
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State | UT
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Zip | 84107-2776
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Country | US
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Telephone | 801-268-1564
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Fax | 801-268-1565
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Authorized Official
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Title or Position | BOARD MEMBER AND CLINICAL DIRECTOR
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Name | ROBERT FREDERICK PRAMANN
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Credential | PH.D.
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Telephone | 801-268-1564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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