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General NPI Number Information
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NPI Number | 1780363713
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Entity Type | Organization
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Legal Business Name | HUB MEDICAL AND BEHAVIORAL
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 1309 W SOUTH JORDAN PKWY STE 200
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-9002
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Country | US
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Telephone | 801-680-8751
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Fax |
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Provider Business Mailing Address
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Address Line | 461 W 13490 S
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City | DRAPER
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State | UT
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Zip | 84020-7223
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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 | GROUP OWNER
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Name | NEIL PATRICK WARDLE
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Credential |
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Telephone | 801-680-8751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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