Organization
UNI BEHAVIORAL HEALTH CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNINE RUSHTON-FOWLER (CONTRACTING DIRECTOR)
(801) 587-6336
Entity
Organization
Contact information
Practice address
650 KOMAS DR, 208, SLC, UT 84108-1215
(801) 585-1212
(801) 585-9096
Mailing address
PO BOX 413076, SALT LAKE CITY, UT 84141-3076
(801) 585-1212
(801) 585-9096
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/14/2006
Last updated
05/28/2015
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