Basic Information
| Provider Information | |||||||||
| NPI: | 1720140114 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNI BEHAVIORAL HEALTH CLINICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 413076 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841413076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015851212 | ||||||||
| FaxNumber: | 8015859096 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 KOMAS DR | ||||||||
| Address2: | 208 | ||||||||
| City: | SLC | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841081215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015851212 | ||||||||
| FaxNumber: | 8015859096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 05/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | RUSHTON-FOWLER | ||||||||
| AuthorizedOfficialFirstName: | JEANNINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACTING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8015876336 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.