Provider Demographics
NPI:1356847206
Name:UTAH PSYCHIATRIC CLINIC, LLC
Entity Type:Organization
Organization Name:UTAH PSYCHIATRIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:INOUYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-592-2002
Mailing Address - Street 1:12221 S 900 E
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7413
Mailing Address - Country:US
Mailing Address - Phone:801-592-2002
Mailing Address - Fax:
Practice Address - Street 1:12221 S 900 E
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7413
Practice Address - Country:US
Practice Address - Phone:801-592-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-31
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty