Provider Demographics
NPI:1003243940
Name:WASATCH MENTAL HEALTH
Entity Type:Organization
Organization Name:WASATCH MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINGHURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-310-4903
Mailing Address - Street 1:760 N 800 E
Mailing Address - Street 2:#102
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6915
Mailing Address - Country:US
Mailing Address - Phone:801-694-9228
Mailing Address - Fax:
Practice Address - Street 1:750 N FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1677
Practice Address - Country:US
Practice Address - Phone:801-373-4760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health