Organization
WASATCH YOUTH SUPPORT SYSTEMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES RUSSELL MARCHEL PH.D. (AGENCY ADMINISTRATOR)
(801) 969-3307
Entity
Organization
Contact information
Practice address
3392 W 3500 S, WEST VALLEY CITY, UT 84119-2630
(801) 969-3307
(801) 964-8898
Mailing address
3392 W 3500 S, WEST VALLEY CITY, UT 84119-2630
(801) 969-3307
(801) 964-8898
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
48920353501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261QR0405X
—
UT
Enumeration date
11/24/2010
Last updated
11/24/2010
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