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General NPI Number Information
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NPI Number | 1265941702
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Entity Type | Organization
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Legal Business Name | SILVER CREEK PSYCHIATRY
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Dates
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Enumeration Date | 09/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1480 E 820 N
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City | OREM
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State | UT
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Zip | 84097-5481
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Country | US
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Telephone | 801-830-8541
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Fax |
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Provider Business Mailing Address
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Address Line | 1480 E 820 N
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City | OREM
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State | UT
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Zip | 84097-5481
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Country | US
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Telephone | 801-830-8541
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Fax |
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Authorized Official
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Title or Position | RN/DON
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Name | TARA GLEAVE
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Credential | DON/RN
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Telephone | 801-830-8541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 6147456-1204
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License Number State | UT
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