Organization
WASATCH BEHAVIORAL HEALTH SPECIAL SERVICE DISTRICT
Active
Other names
Wasatch Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DORAN WILLIAMS LCSW (ASSOCIATE DIRECTORE)
(801) 373-4760
Entity
Organization
Contact information
Practice address
750 N FREEDOM BLVD, SUITE 300, PROVO, UT 84601
(801) 373-4760
(801) 373-0639
Mailing address
750 N FREEDOM BLVD, SUITE 300, PROVO, UT 84601
(801) 373-4760
(801) 373-0639
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
UT
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870285565012
—
UT
Enumeration date
08/01/2006
Last updated
04/30/2021
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