Healthcare Provider Details

I. General information

NPI: 1366408874
Provider Name (Legal Business Name): VALLEY MENTAL HEALTH INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 HIGHLAND DR SUITE 100
SALT LAKE CITY UT
84124-3543
US

IV. Provider business mailing address

5965 S 900 E SUITE 420
SALT LAKE CITY UT
84121-1720
US

V. Phone/Fax

Practice location:
  • Phone: 801-273-1085
  • Fax: 801-273-4097
Mailing address:
  • Phone: 801-263-7100
  • Fax: 801-263-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number StateUT
# 5
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number StateUT

VIII. Authorized Official

Name: MS. DEBRA FALVO
Title or Position: EXECUTIVE DIRECTOR
Credential: MHCA/RN
Phone: 801-263-7100