Organization
UNIVERSITY OF UTAH MEDICAL CENTER PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNARD I GROSSER MD (DEPARTMENT CHAIR)
(801) 581-7951
Entity
Organization
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-7951
Mailing address
PO BOX 581079, SALT LAKE CITY, UT 84158-1079
(801) 213-3800
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100503238
NEVADA MEDICAID
NV
01
—
122245700
WYOMING MEDICAID
WY
01
—
805754300
IDAHO MEDICAID
ID
Enumeration date
06/25/2006
Last updated
09/06/2011
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