Provider Demographics
NPI:1568529188
Name:SJV, INC. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SJV, INC. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARECHOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-277-8100
Mailing Address - Street 1:4505 WASATCH BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4709
Mailing Address - Country:US
Mailing Address - Phone:801-277-8100
Mailing Address - Fax:801-277-8800
Practice Address - Street 1:4505 WASATCH BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4709
Practice Address - Country:US
Practice Address - Phone:801-277-8100
Practice Address - Fax:801-277-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134414-3501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health