MEDICARE: CENTER FOR HUMAN POTENTIAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1548239940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR HUMAN POTENTIAL INC

Provider Business Mailing Address
First Line	:	525 E 100 S
Second Line	:	SUITE 120
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-4210
Country	:	US
Telephone Number	:	801-483-2447
Fax Number	:	801-486-8705

Provider Business Practice Location Address
First Line	:	525 E 100 S
Second Line	:	SUITE 120
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2070
Country	:	US
Telephone Number	:	801-483-2447
Fax Number	:	801-486-8705

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	ANTHONY C MORRISON
Credential	:	PH.D.
Telephone Number	:	801-483-2447

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	03/11/2015

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