Provider Demographics
NPI:1538433388
Name:SALT LAKE MENTAL HEALTH, P.C.
Entity type:Organization
Organization Name:SALT LAKE MENTAL HEALTH, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:801-244-9049
Mailing Address - Street 1:220 E 3900 S
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-1556
Mailing Address - Country:US
Mailing Address - Phone:801-244-9049
Mailing Address - Fax:
Practice Address - Street 1:220 E 3900 S
Practice Address - Street 2:SUITE 7
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1556
Practice Address - Country:US
Practice Address - Phone:801-244-9049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5078405-6004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health