Organization
FAMILY CONNECTION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON WILDE LPC (EXECUTIVE DIRECTOR)
(801) 773-0712
Entity
Organization
Contact information
Practice address
875 E HIGHWAY 193, LAYTON, UT 84040-6544
(801) 771-4642
(801) 774-8267
Mailing address
1360 E 1450 S, CLEARFIELD, UT 84015-1611
(801) 773-0712
(801) 774-8267
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
17951
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260022408
RAILROAD MEDICARE
UT
05
—
876000308007
—
UT
Enumeration date
09/27/2011
Last updated
09/27/2011
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