Provider Demographics
NPI:1417913930
Name:VALLEY MENTAL HEALTH INCORPORATED
Entity Type:Organization
Organization Name:VALLEY MENTAL HEALTH INCORPORATED
Other - Org Name:CLOZARIL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALVO
Authorized Official - Suffix:
Authorized Official - Credentials:MHCA/RN
Authorized Official - Phone:801-263-7100
Mailing Address - Street 1:5965 S 900 E
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1720
Mailing Address - Country:US
Mailing Address - Phone:801-263-7100
Mailing Address - Fax:801-263-7123
Practice Address - Street 1:1141 E 3900 S
Practice Address - Street 2:SUITE A250
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1215
Practice Address - Country:US
Practice Address - Phone:801-284-4900
Practice Address - Fax:801-284-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YM0800X, 104100000X, 1041C0700X, 163WP0809X, 2084P0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2423OtherPEHP
UT2423OtherPEHP
UT=========014Medicaid
UT=========031MedicaidA&D MEDICAID CONTRACT
UT=========014MedicaidCAPITATED MEDICAID
UT=========00001OtherBLUE CROSS OF UTAH
UT=========014MedicaidCAPITATED MEDICAID