| Family Support Center | |
|
777 W Center St Midvale UT 84047-7148 | |
| (801) 955-9411 | |
| (801) 955-9411 |
| Full Name | Family Support Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 777 W Center St, Midvale, Utah |
| Authorized Official Name and Position | Paul M. Ricks (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8019559110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Support Center 1760 W 4805 S Taylorsville UT 84118-1177 Ph: (801) 955-9110 | Family Support Center 777 W Center St Midvale UT 84047-7148 Ph: (801) 955-9411 |
| NPI Number | 1568510550 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 06/20/2011 |
| Medicare PECOS PAC ID | 7810212594 |
|---|---|
| Medicare Enrollment ID | O20150223000490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568510550 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 17474 (Utah) | Secondary |
| 251S00000X | Community/behavioral Health | 12358 (Utah) | Primary |
| Provider Name | David M Ockey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376835793 PECOS PAC ID: 9638398944 Enrollment ID: I20140918002706 |
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