Organization
BONNEVILLE MENTAL HEALTH, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATE GREEN (DIRECTOR OF OPERATIONS)
(435) 228-4181
Entity
Organization
Contact information
Practice address
134 W 1180 N STE 4, TOOELE, UT 84074-1483
(435) 228-4181
Mailing address
134 W 1180 N STE 4, TOOELE, UT 84074-1483
(435) 228-4181
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
2903
UT
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
2903
UT
Other
Enumeration date
11/20/2013
Last updated
05/10/2016
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