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NPI Code Detail

MEDICARE: ABS UTAH, P.C.

MEDICARE: ABS UTAH, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1053821728
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABS UTAH, P.C.
Provider Business Mailing Address
First Line : 16255 VENTURA BLVD STE 900
Second Line :
City : ENCINO
State : CA
Zip : 91436-2317
Country : US
Telephone Number : 801-935-4171
Fax Number : 801-935-4946
Provider Business Practice Location Address
First Line : 240 MORRIS AVE STE 100
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-3278
Country : US
Telephone Number : 801-935-4171
Fax Number : 801-935-4946
Authorized Official
Title or Position : MANAGER, CONTRACTING
Name : GLENN WIGER
Credential :
Telephone Number : 818-900-0681
Provider Enumeration Date : 10/06/2017
Last Update Date : 09/10/2025

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