Organization Name: | A SAFE PLACE |
NPI Number: | 1073877726 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RYAN KELLY GRANT (LCSW) |
Mailing Address: | 11075 S State St Ste 30 Sandy |
State: | UT US |
Postal Code: | 840705129 |
Phone Number: | 8017938774 |
Fax Number: | |
NPI Enumeration Date: | 06/27/2012 |
NPI Last Update Date: | 07/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |