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General NPI Number Information
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NPI Number | 1871928267
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Entity Type | Organization
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Legal Business Name | WASATCH MENTAL HEALTH
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 750 N FREEDOM BLVD
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City | PROVO
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State | UT
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Zip | 84601-1677
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Country | US
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Telephone | 801-373-4760
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Fax |
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Provider Business Mailing Address
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Address Line | 750 N FREEDOM BLVD
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City | PROVO
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State | UT
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Zip | 84601-1677
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Country | US
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Telephone | 801-373-4760
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | KYLE BRINGHURST
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Credential |
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Telephone | 801-310-4903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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