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Organization
TRAUMA CENTER OF UTAH, LLC
Active
Organization
TRAUMA CENTER OF UTAH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA PORTER LMHC (CLINICAL DIRECTOR)
(801) 851-5504
Entity
Organization
Contact information
Practice address
4980 N UNIVERSITY AVE APT 12, PROVO, UT 84604-6444
(801) 644-4014
Mailing address
4980 N UNIVERSITY AVE APT 12, PROVO, UT 84604-6444
(801) 644-4014
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
12/31/2018
Last updated
12/31/2018
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