Provider Demographics
NPI:1497277750
Name:YOUNG MINDS THERAPY
Entity Type:Organization
Organization Name:YOUNG MINDS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-987-0727
Mailing Address - Street 1:231 E 400 S STE 320
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2813
Mailing Address - Country:US
Mailing Address - Phone:801-987-0727
Mailing Address - Fax:
Practice Address - Street 1:231 E 400 S STE 320
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2813
Practice Address - Country:US
Practice Address - Phone:801-987-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)