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General NPI Number Information
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NPI Number | 1912371378
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Entity Type | Organization
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Legal Business Name | FOUNDATION FOR FAMILY LIFE
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 11978 S REDWOOD RD
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City | RIVERTON
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State | UT
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Zip | 84065-7403
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Country | US
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Telephone | 801-750-5398
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Fax |
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Provider Business Mailing Address
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Address Line | 1875 W 12600 S # 230
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City | RIVERTON
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State | UT
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Zip | 84065-7044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JOSEPH WHITE
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Credential | PH.D.
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Telephone | 801-750-5398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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