Healthcare Provider Details

I. General information

NPI: 1508216169
Provider Name (Legal Business Name): UNIVERSITY OF UTAH BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 S 200 W
FARMINGTON UT
84025-2419
US

IV. Provider business mailing address

PO BOX 413076
SALT LAKE CITY UT
84141-3076
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-6336
  • Fax:
Mailing address:
  • Phone: 801-213-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES A ASHWORTH
Title or Position: DEPARTMENT CHAIR
Credential: MD
Phone: 801-587-6336