Provider Demographics
NPI:1649466814
Name:VALLEY MENTAL HEALTH INCORPORATED
Entity type:Organization
Organization Name:VALLEY MENTAL HEALTH INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FALVO
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA/RNC
Authorized Official - Phone:801-263-7100
Mailing Address - Street 1:5965 S 900 E
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1720
Mailing Address - Country:US
Mailing Address - Phone:801-263-7100
Mailing Address - Fax:801-263-7123
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-3176
Practice Address - Country:US
Practice Address - Phone:801-536-6510
Practice Address - Fax:801-536-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========014Medicaid