Organization
RANDY RAY ENTERPRISES LLC
Active
Other names
Intentional Family Institute
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN L. JOHNSON LMFT (PARTNER/PROGRAM DIRECTOR)
(801) 738-4369
Entity
Organization
Contact information
Practice address
3900 SOUTH AVENUE, 220 EAST AVENUE, SUITE 7, SALT LAKE CITY, UT 84107
(801) 738-4369
Mailing address
2936 LAKE MARY DR, SALT LAKE CITY, UT 84121-5331
(801) 860-9627
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
59432763902
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11798095
CAQH
UT
Enumeration date
11/13/2009
Last updated
11/13/2009
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