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General NPI Number Information
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NPI Number | 1295164408
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Entity Type | Organization
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Legal Business Name | HEART SMITH RECOVERY
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 32 W WINCHESTER ST 101
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City | MURRAY
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State | UT
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Zip | 84107-5607
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Country | US
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Telephone | 801-263-6367
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Fax | 801-263-6370
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Provider Business Mailing Address
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Address Line | 32 W WINCHESTER ST 101
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City | MURRAY
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State | UT
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Zip | 84107
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Country | US
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Telephone | 801-263-6367
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Fax | 801-263-6370
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Authorized Official
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Title or Position | CO OWNER
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Name | CAMILLE CAMPBELL
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Credential | LCSW
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Telephone | 801-263-6367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 21266
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License Number State | UT
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