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General NPI Number Information
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NPI Number | 1558243691
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Entity Type | Organization
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Legal Business Name | BEAVER CREEK MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 851 N MAIN ST
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City | LOGAN
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State | UT
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Zip | 84321-3228
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Country | US
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Telephone | 435-215-1775
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Fax |
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Provider Business Mailing Address
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Address Line | 97 N MAIN ST
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City | PROVIDENCE
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State | UT
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Zip | 84332-9601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CODY COX
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Credential | CMHC
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Telephone | 435-215-1775
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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 |
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License Number State |
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