Organization
CLINICAL CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL R. ODOM LSAC (ADMINISTRATOR)
(801) 233-8670
Entity
Organization
Contact information
Practice address
2351 GRANT AVE, SUITE 100, OGDEN, UT 84401-1406
(801) 621-8670
(801) 621-4512
Mailing address
2351 GRANT AVE, SUITE 100, OGDEN, UT 84401-1406
(801) 621-8670
(801) 621-4512
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
12931
UT
Other
Enumeration date
06/27/2007
Last updated
08/22/2020
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