Healthcare Provider Details

I. General information

NPI: 1184790370
Provider Name (Legal Business Name): BEHAVIORAL HEALTH ASSOCIATES OF UTAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N MAIN ST SUITE I
RICHFIELD UT
84701-2168
US

IV. Provider business mailing address

108 N MAIN ST SUITE I
RICHFIELD UT
84701-2168
US

V. Phone/Fax

Practice location:
  • Phone: 435-896-5165
  • Fax: 435-578-8008
Mailing address:
  • Phone: 435-896-5165
  • Fax: 435-578-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number368809-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1022722501
License Number StateUT

VIII. Authorized Official

Name: RONALD B FRANCE
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 801-580-9192