Organization
FRESH START BEHAVIORAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANE CANNON PORTER CMHC (DIRECTOR)
(801) 566-2468
Entity
Organization
Contact information
Practice address
8841 S REDWOOD RD STE D1, WEST JORDAN, UT 84088-9290
(801) 566-2468
(855) 787-6818
Mailing address
8841 S REDWOOD RD STE D1, WEST JORDAN, UT 84088-9290
(801) 566-2468
(855) 787-6818
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2885
—
Other
Enumeration date
11/09/2013
Last updated
11/09/2013
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