MEDICARE: CHILD & FAMILY EMPOWERMENT SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	136834-3501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568424828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD & FAMILY EMPOWERMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	1578 W 1700 S
Second Line	:	SUITE #200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-3470
Country	:	US
Telephone Number	:	801-972-2711
Fax Number	:	801-972-2709

Provider Business Practice Location Address
First Line	:	1578 W 1700 S
Second Line	:	SUITE #200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-3470
Country	:	US
Telephone Number	:	801-972-2711
Fax Number	:	801-972-2709

Authorized Official
Title or Position	:	OWNER/CLINICAL DIRECTOR
Name	:	MRS. LEILANI ANNE TAHOLO
Credential	:	LCSW
Telephone Number	:	801-972-2711

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	08/22/2020

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