Organization
FAMILY SUPPORT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL M RICKS LCSW (CLINICAL DIRECTOR)
(801) 995-9110
Entity
Organization
Contact information
Practice address
3663 S 3600 W, WEST VALLEY CITY, UT 84119-2570
(801) 967-4259
(801) 964-1534
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
Primary
17461
UT
Other
Enumeration date
06/07/2011
Last updated
06/07/2011
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