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General NPI Number Information
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NPI Number | 1639589344
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Entity Type | Organization
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Legal Business Name | SALT LAKE COUNTY YOUTH SERVICES
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 177 W PRICE AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-4345
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Country | US
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Telephone | 385-468-4500
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Fax | 385-468-4461
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Provider Business Mailing Address
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Address Line | 177 W PRICE AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-4345
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Country | US
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Telephone | 385-468-4500
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Fax | 385-468-4461
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Authorized Official
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Title or Position | COUNSELING SERVICES COORDINATOR
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Name | DEBBIE OSBORNE
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Credential |
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Telephone | 385-468-4519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 1558665026
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License Number State | UT
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