Provider Demographics
NPI:1558665026
Name:SALT LAKE COUNTY YOUTH SERVICES DIVISION
Entity Type:Organization
Organization Name:SALT LAKE COUNTY YOUTH SERVICES DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-468-4501
Mailing Address - Street 1:177 WEST PRICE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-4345
Mailing Address - Country:US
Mailing Address - Phone:801-269-7500
Mailing Address - Fax:801-269-7547
Practice Address - Street 1:177 WEST PRICE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-4345
Practice Address - Country:US
Practice Address - Phone:801-269-7500
Practice Address - Fax:801-269-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT137956-6004101YP2500X
UT4909154-6004101YP2500X
UT353260-6004101YP2500X
UT5076247-6004101YP2500X
UT333128-35011041C0700X
UT340061-35011041C0700X
UT331348-35011041C0700X
UT347531-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTHT002258-002OtherUTAH HEALTH
UTHT004-001Medicaid