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NPI Code Detail

MEDICARE: ENCIRCLE FAMILY AND YOUTH RESOURCE CENTER

MEDICARE: ENCIRCLE FAMILY AND YOUTH RESOURCE CENTER
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1619435344
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENCIRCLE FAMILY AND YOUTH RESOURCE CENTER
Provider Business Mailing Address
First Line : 331 S 600 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-4013
Country : US
Telephone Number : 801-610-6720
Fax Number :
Provider Business Practice Location Address
First Line : 331 S 600 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-4013
Country : US
Telephone Number : 801-610-6720
Fax Number :
Authorized Official
Title or Position : CDO
Name : LANDON CREER
Credential :
Telephone Number : 801-610-6720
Provider Enumeration Date : 03/12/2019
Last Update Date : 03/12/2019

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Directions to “ENCIRCLE FAMILY AND YOUTH RESOURCE CENTER ” Practice Location

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