Provider Demographics
NPI:1033410048
Name:UTAH NEUROTHERAPY CENTER
Entity Type:Organization
Organization Name:UTAH NEUROTHERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-529-8279
Mailing Address - Street 1:129 S STATE ST STE 250
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1116
Mailing Address - Country:US
Mailing Address - Phone:801-529-8279
Mailing Address - Fax:801-820-8655
Practice Address - Street 1:129 S STATE ST STE 250
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1116
Practice Address - Country:US
Practice Address - Phone:801-855-7999
Practice Address - Fax:801-855-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-07
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6783831-3501261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)