Provider Demographics
NPI:1861883738
Name:UINTAH BASIN TRICOUNTY MENTAL HEALTH & SUBSTANCE ABUSE LOCAL AUTHORITY
Entity type:Organization
Organization Name:UINTAH BASIN TRICOUNTY MENTAL HEALTH & SUBSTANCE ABUSE LOCAL AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORT SERVICES COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-725-6300
Mailing Address - Street 1:285 W 800 S
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-3707
Mailing Address - Country:US
Mailing Address - Phone:435-725-6300
Mailing Address - Fax:435-725-6325
Practice Address - Street 1:1140 W 500 S STE 9
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2912
Practice Address - Country:US
Practice Address - Phone:435-725-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management