Provider Demographics
NPI:1548510092
Name:EARLY LIFE CHILD PSYCHOLOGY & EDUCATION CENTER, INC.
Entity type:Organization
Organization Name:EARLY LIFE CHILD PSYCHOLOGY & EDUCATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:801-984-2877
Mailing Address - Street 1:10808 S RIVER FRONT PKWY STE 314
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5761
Mailing Address - Country:US
Mailing Address - Phone:801-984-2877
Mailing Address - Fax:801-790-0139
Practice Address - Street 1:10808 S RIVER FRONT PKWY STE 314
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5761
Practice Address - Country:US
Practice Address - Phone:801-984-2877
Practice Address - Fax:801-790-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT75389702501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty