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Organization

FAMILY SUPPORT CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. PAUL M. RICKS LCSW (CLINICAL DIRECTOR)
(801) 955-9110
Entity
Organization

Contact information

Practice address
777 W CENTER ST, MIDVALE, UT 84047-7148
(801) 955-9411
(801) 955-9411
Mailing address
1760 W 4805 S, TAYLORSVILLE, UT 84118-1177
(801) 955-9110
(801) 955-9411

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
17474
UT
251S00000X
Community/Behavioral Health Agency
Primary
12358
UT

Other

Enumeration date
01/08/2007
Last updated
06/20/2011
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