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Organization
STATE OF UTAH
Active
Organization
STATE OF UTAH
Active
Parent organization
STATE OF UTAH
Other names
Juvenile Justice and Youth Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF UTAH
Authorized official
BRETT PETERSEN (DIVISION DIRECTOR)
(801) 538-4330
Entity
Organization
Contact information
Practice address
195 N 1950 W, SLC, UT 84116-3100
(801) 538-4330
Mailing address
195 N 1950 W, SLC, UT 84116-3100
Taxonomy
Speciality
Code
Description
License number
State
261QP2400X
Prison Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
11/19/2024
Last updated
11/19/2024
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