Healthcare Provider Details

I. General information

NPI: 1912092586
Provider Name (Legal Business Name): UTAH COUNTY COUNCIL ON DRUG ABUSE REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 EAST 1200 SOUTH
OREM UT
84058
US

IV. Provider business mailing address

251 EAST 1200 SOUTH
OREM UT
84058
US

V. Phone/Fax

Practice location:
  • Phone: 801-226-2266
  • Fax: 801-226-2578
Mailing address:
  • Phone: 801-226-2266
  • Fax: 801-226-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number11904
License Number StateUT

VIII. Authorized Official

Name: TIMOTHY E ADAMS
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 801-226-2255