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NPI Code Detail

MEDICARE: VALLEY MENTAL HEALTH INCORPORATED

MEDICARE: VALLEY MENTAL HEALTH INCORPORATED
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
11041C0700XClinical Social WorkerUT
2163WP0809XAdult Psychiatric/Mental Health Registered NurseUT
3164W00000XLicensed Practical NurseUT
4363LP0808XPsychiatric/Mental Health Nurse PractitionerUT
52084P0800XPsychiatry PhysicianUT

General Provider Information

NPI Number : 1205892080
Entity Type Code : Organization
Provider Name (Legal Business Name) : VALLEY MENTAL HEALTH INCORPORATED
Provider Business Mailing Address
First Line : 5965 S 900 E
Second Line : SUITE 420
City : SALT LAKE CITY
State : UT
Zip : 84121-1720
Country : US
Telephone Number : 801-263-7100
Fax Number : 801-263-7123
Provider Business Practice Location Address
First Line : 2472 S 300 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-2895
Country : US
Telephone Number : 801-415-7591
Fax Number : 801-415-7533
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. DEBRA LYNN S FALVO
Credential : MHCA/RN
Telephone Number : 801-263-7100
Provider Enumeration Date : 04/21/2006
Last Update Date : 08/25/2011

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Directions to “VALLEY MENTAL HEALTH INCORPORATED ” Practice Location

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