Provider Demographics
NPI:1053666883
Name:SALT LAKE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SALT LAKE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-264-6000
Mailing Address - Street 1:3802 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1182
Mailing Address - Country:US
Mailing Address - Phone:801-264-6000
Mailing Address - Fax:801-264-6070
Practice Address - Street 1:3802 S 700 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1182
Practice Address - Country:US
Practice Address - Phone:801-264-6000
Practice Address - Fax:801-264-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT225374-4405283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital