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Organization
DE NOVO SERVICES LLC
Active
Organization
DE NOVO SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY COSTLEY (DIRECTOR / OWNER)
(801) 263-1056
Entity
Organization
Contact information
Practice address
339 E 3900 S, SUITE 155, SALT LAKE CITY, UT 84107-1677
(801) 263-1056
(801) 261-3701
Mailing address
339 E 3900 S, SUITE 155, SALT LAKE CITY, UT 84107-1677
(801) 263-1056
(801) 261-3701
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
3336I0012X
Institutional Pharmacy
Primary
—
—
Other
Enumeration date
02/02/2012
Last updated
08/03/2020
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