Healthcare Provider Details

I. General information

NPI: 1295792117
Provider Name (Legal Business Name): VALLEY MENTAL HEALTH INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 HIGHLAND DR SUITE 300
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: 801-273-6366
  • Fax: 801-273-6363
Mailing address:
  • Phone: 801-263-7100
  • Fax: 801-263-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateUT
# 6
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateUT

VIII. Authorized Official

Name: MS. GARY LARCENAIRE
Title or Position: CEO/PRESIDENT
Credential:
Phone: 801-263-7100