Healthcare Provider Details

I. General information

NPI: 1245687763
Provider Name (Legal Business Name): SALT PSYCHOLOGICAL AND BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9710 S 700 E SUITE 111
SANDY UT
84070-3594
US

IV. Provider business mailing address

9710 S 700 E SUITE 111
SANDY UT
84070-3594
US

V. Phone/Fax

Practice location:
  • Phone: 801-768-0608
  • Fax:
Mailing address:
  • Phone: 801-768-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD THUESON
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 801-768-0608