Provider Demographics
NPI:1023369493
Name:WASATCH MENTAL HEALTH
Entity Type:Organization
Organization Name:WASATCH MENTAL HEALTH
Other - Org Name:WATCH
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MANAGER, COMMUNITY SERIVES
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-373-7394
Mailing Address - Street 1:299 E 900 S
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6107
Mailing Address - Country:US
Mailing Address - Phone:801-852-3779
Mailing Address - Fax:801-374-7304
Practice Address - Street 1:299 E 900 S
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-6107
Practice Address - Country:US
Practice Address - Phone:801-852-3779
Practice Address - Fax:801-374-7304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management