Provider Demographics
NPI:1144899170
Name:FAMILY MENTAL HEALTH
Entity type:Organization
Organization Name:FAMILY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:435-650-9854
Mailing Address - Street 1:2210 E 550 N
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1522
Mailing Address - Country:US
Mailing Address - Phone:435-650-9854
Mailing Address - Fax:435-200-3579
Practice Address - Street 1:1060 S MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5260
Practice Address - Country:US
Practice Address - Phone:435-650-9854
Practice Address - Fax:435-200-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty