Provider Demographics
NPI:1508309287
Name:TELOS
Entity Type:Organization
Organization Name:TELOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAMREON
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-426-8800
Mailing Address - Street 1:870 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-5202
Mailing Address - Country:US
Mailing Address - Phone:801-426-8800
Mailing Address - Fax:801-426-8825
Practice Address - Street 1:870 W CENTER ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-5202
Practice Address - Country:US
Practice Address - Phone:801-426-8800
Practice Address - Fax:801-426-8825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TELOS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT66066303501323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility