Healthcare Provider Details

I. General information

NPI: 1265941702
Provider Name (Legal Business Name): SILVER CREEK PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

1480 E 820 N
OREM UT
84097-5481
US

V. Phone/Fax

Practice location:
  • Phone: 801-830-8541
  • Fax:
Mailing address:
  • Phone: 801-830-8541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6147456-1204
License Number StateUT

VIII. Authorized Official

Name: TARA GLEAVE
Title or Position: RN/DON
Credential: DON/RN
Phone: 801-830-8541