Provider Demographics
NPI:1639777568
Name:MEGAN KOMATSU INC.
Entity Type:Organization
Organization Name:MEGAN KOMATSU INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMATSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-455-0150
Mailing Address - Street 1:5526 W 13400 S STE 544
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6919
Mailing Address - Country:US
Mailing Address - Phone:801-455-0150
Mailing Address - Fax:
Practice Address - Street 1:10815 700 EAST
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070
Practice Address - Country:US
Practice Address - Phone:801-455-0150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty