Organization
MODERN EVE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON RICKS LMFT (PRESIDENT)
(801) 695-9955
Entity
Organization
Contact information
Practice address
323 E STANTON AVE # A, SLC, UT 84111-3519
(801) 695-9955
Mailing address
323 E STANTON AVE # A, SLC, UT 84111-3519
(801) 695-9955
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
133V00000X
Registered Dietitian
—
—
Other
Enumeration date
03/04/2021
Last updated
03/04/2021
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