1316952856 NPI number — CENTRAL UTAH MENTAL HEALTH SUBSTANCE ABUSE

Table of content: NANCY LIUZZA (NPI 1841785748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316952856 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:
Provider Other Organization Name Type Code:
6
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:
1316952856
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:
125 S STATE ST
Provider Second Line Business Practice Location Address:
#20
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84647-1563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-462-2421
Provider Business Practice Location Address Fax Number:
435-462-0278
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: 320600000X , with the licence number:  11246 , 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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