Provider Demographics
NPI:1215999503
Name:INTERMOUNTAIN SPECIALIZED ABUSE TREATMENT CENTER (ISAT)
Entity type:Organization
Organization Name:INTERMOUNTAIN SPECIALIZED ABUSE TREATMENT CENTER (ISAT)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-EXECUTIVE DIRECTOR/CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALCARCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:801-886-8900
Mailing Address - Street 1:1555 WEST 2200 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1486
Mailing Address - Country:US
Mailing Address - Phone:801-886-8900
Mailing Address - Fax:801-886-8898
Practice Address - Street 1:1555 WEST 2200 SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1486
Practice Address - Country:US
Practice Address - Phone:801-886-8900
Practice Address - Fax:801-886-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1358386004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1215999503Medicaid