1982619326 NPI number — CENTRAL UTAH MENTAL HEALTH SUBSTANCE ABUSE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982619326 NPI number — CENTRAL UTAH MENTAL HEALTH SUBSTANCE ABUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL UTAH MENTAL HEALTH SUBSTANCE ABUSE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTRAL UTAH COUNSELING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982619326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84647-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-462-2416
Provider Business Mailing Address Fax Number:
435-462-9350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 W 100 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRAIM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84627-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-283-4065
Provider Business Practice Location Address Fax Number:
435-283-5387
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARX
Authorized Official First Name:
FARREL
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL OFFICER
Authorized Official Telephone Number:
435-462-2416

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  11190 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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