Provider Demographics
NPI:1255342127
Name:CENTRAL UTAH MENTAL HEALTH SUBSTANCE ABUSE
Entity type:Organization
Organization Name:CENTRAL UTAH MENTAL HEALTH SUBSTANCE ABUSE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-283-8400
Mailing Address - Street 1:152 N 400 W
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-5549
Mailing Address - Country:US
Mailing Address - Phone:435-283-8400
Mailing Address - Fax:435-283-8401
Practice Address - Street 1:550 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JUNCTION
Practice Address - State:UT
Practice Address - Zip Code:84740-8001
Practice Address - Country:US
Practice Address - Phone:435-896-8236
Practice Address - Fax:435-896-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11203251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11203OtherSTATE LICENSE