Healthcare Provider Details

I. General information

NPI: 1255342127
Provider Name (Legal Business Name): CENTRAL UTAH MENTAL HEALTH SUBSTANCE ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N MAIN ST
JUNCTION UT
84740-8001
US

IV. Provider business mailing address

152 N 400 W
EPHRAIM UT
84627-5549
US

V. Phone/Fax

Practice location:
  • Phone: 435-896-8236
  • Fax: 435-896-9584
Mailing address:
  • Phone: 435-283-8400
  • Fax: 435-283-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number11203
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier11203
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name: RICHARD ANDERSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 435-283-8400