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NPI Code Detail

MEDICARE: TRAUMA AWARENESS & TREATMENT CENTER, INC.

MEDICARE: TRAUMA AWARENESS & TREATMENT CENTER, INC.
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
1101YM0800XMental Health Counselor10844UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770542219
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRAUMA AWARENESS & TREATMENT CENTER, INC.
Provider Business Mailing Address
First Line : 32 W WINCHESTER ST
Second Line : SUITE 101
City : SALT LAKE CITY
State : UT
Zip : 84107-5607
Country : US
Telephone Number : 801-263-6367
Fax Number : 801-263-6370
Provider Business Practice Location Address
First Line : 32 W WINCHESTER ST
Second Line : SUITE 101
City : SALT LAKE CITY
State : UT
Zip : 84107-5607
Country : US
Telephone Number : 801-263-6367
Fax Number : 801-263-6370
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : DR. LAWRENCE DALTON BEALL
Credential : PH.D.
Telephone Number : 801-263-6367
Provider Enumeration Date : 03/22/2006
Last Update Date : 08/22/2020

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