Provider Demographics
NPI:1275230344
Name:AUTHENTICALLY YOU MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:AUTHENTICALLY YOU MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR/OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAEIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVED
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-634-3782
Mailing Address - Street 1:5506 W BAILIFF DR
Mailing Address - Street 2:
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118-7302
Mailing Address - Country:US
Mailing Address - Phone:385-217-4087
Mailing Address - Fax:801-203-5160
Practice Address - Street 1:5506 W BAILIFF DR
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-7302
Practice Address - Country:US
Practice Address - Phone:385-217-4087
Practice Address - Fax:801-203-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)