Healthcare Provider Details

I. General information

NPI: 1588694277
Provider Name (Legal Business Name): FOUR CORNERS COMMUNITY BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 E MAIN ST
PRICE UT
84501-3166
US

IV. Provider business mailing address

PO BOX 867
PRICE UT
84501-0867
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-7200
  • Fax: 435-637-2377
Mailing address:
  • Phone: 435-637-7200
  • Fax: 435-637-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number11672
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HUNTINGTON
Title or Position: EXECUTIVE DIRECTOR
Credential: CMHC
Phone: 435-613-2179