Healthcare Provider Details

I. General information

NPI: 1063552305
Provider Name (Legal Business Name): UT-TEX, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8265 W 2700 S
MAGNA UT
84044-1323
US

IV. Provider business mailing address

8265 W 2700 S
MAGNA UT
84044-1323
US

V. Phone/Fax

Practice location:
  • Phone: 801-446-6312
  • Fax: 801-446-7746
Mailing address:
  • Phone: 801-446-6312
  • Fax: 801-446-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number12385
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number12385
License Number StateUT

VIII. Authorized Official

Name: H MATTHEW DIXON JR.
Title or Position: OWNER
Credential:
Phone: 801-446-6312