Provider Demographics
NPI:1306010574
Name:CLINICAL CONSULTANTS, LLC
Entity Type:Organization
Organization Name:CLINICAL CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:LSAC
Authorized Official - Phone:801-233-8670
Mailing Address - Street 1:7601 SO. REDWOOD ROAD
Mailing Address - Street 2:BUILDING E
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-9323
Mailing Address - Country:US
Mailing Address - Phone:801-233-8670
Mailing Address - Fax:801-233-8682
Practice Address - Street 1:7601 SOUTH REDWOOD ROAD
Practice Address - Street 2:BUILDING E
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-9323
Practice Address - Country:US
Practice Address - Phone:801-233-8670
Practice Address - Fax:801-233-8682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 291U00000X
UT16640261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No291U00000XLaboratoriesClinical Medical Laboratory