Provider Demographics
NPI:1548338833
Name:INTERFACE PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:INTERFACE PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-328-8817
Mailing Address - Street 1:508 E SOUTH TEMPLE STE 201
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1099
Mailing Address - Country:US
Mailing Address - Phone:801-328-8817
Mailing Address - Fax:801-366-4284
Practice Address - Street 1:508 E SOUTH TEMPLE STE 201
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1099
Practice Address - Country:US
Practice Address - Phone:801-328-8817
Practice Address - Fax:801-366-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT831271513501101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty