MEDICARE: UNIVERSITY OF UTAH BEHAVIORAL HEALTH SERVICES

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1962866095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF UTAH BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 841450
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-1450
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 MORRIS AVE STE 400
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-3295
Country	:	US
Telephone Number	:	801-587-6336
Fax Number	:

Authorized Official
Title or Position	:	CHIEF CLINICAL OFFICER
Name	:	DR. SAMUEL FINLAYSON
Credential	:	MD
Telephone Number	:	801-587-6336

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	04/13/2022

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