Provider Demographics
NPI:1588847008
Name:INTERMOUNTAIN MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:INTERMOUNTAIN MENTAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-673-4841
Mailing Address - Street 1:PO BOX 57885
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-0885
Mailing Address - Country:US
Mailing Address - Phone:801-673-4841
Mailing Address - Fax:
Practice Address - Street 1:5012 S TIMBER WAY UNIT 206
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84117-5875
Practice Address - Country:US
Practice Address - Phone:801-673-4841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2774677-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty