Provider Demographics
NPI:1720140114
Name:UNI BEHAVIORAL HEALTH CLINICS
Entity type:Organization
Organization Name:UNI BEHAVIORAL HEALTH CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHTON-FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-587-6336
Mailing Address - Street 1:PO BOX 413076
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-3076
Mailing Address - Country:US
Mailing Address - Phone:801-585-1212
Mailing Address - Fax:801-585-9096
Practice Address - Street 1:650 KOMAS DR
Practice Address - Street 2:208
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-1215
Practice Address - Country:US
Practice Address - Phone:801-585-1212
Practice Address - Fax:801-585-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health