Provider Demographics
NPI:1023425931
Name:SEQUOIA FAMILY THERAPY SERVICES LLC
Entity type:Organization
Organization Name:SEQUOIA FAMILY THERAPY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DARRIS
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:385-244-6927
Mailing Address - Street 1:1913 S 1200 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8812
Mailing Address - Country:US
Mailing Address - Phone:385-244-6927
Mailing Address - Fax:
Practice Address - Street 1:8180 S 700 E STE 230
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0570
Practice Address - Country:US
Practice Address - Phone:385-244-6927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8449538-3904251S00000X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health