Provider Demographics
NPI:1457774754
Name:HH WELLNESS GROUP
Entity type:Organization
Organization Name:HH WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDO
Authorized Official - Suffix:IV
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-308-8155
Mailing Address - Street 1:2180 E 4500 S
Mailing Address - Street 2:STE185
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4434
Mailing Address - Country:US
Mailing Address - Phone:801-308-8155
Mailing Address - Fax:801-308-8742
Practice Address - Street 1:2180 E 4500 S
Practice Address - Street 2:STE185
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4434
Practice Address - Country:US
Practice Address - Phone:801-308-8155
Practice Address - Fax:801-308-8742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8516780-0160251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health