Provider Demographics
NPI:1679956437
Name:FIREFLY ADDICTION & FAMILY THERAPY
Entity type:Organization
Organization Name:FIREFLY ADDICTION & FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-676-9160
Mailing Address - Street 1:1270 E 8600 S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-1200
Mailing Address - Country:US
Mailing Address - Phone:801-676-9160
Mailing Address - Fax:
Practice Address - Street 1:1270 E 8600 S
Practice Address - Street 2:SUITE 3
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-1200
Practice Address - Country:US
Practice Address - Phone:801-676-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT79799323902101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty