Provider Demographics
NPI:1649423005
Name:BEACON FAMILY MENTAL HEALTH
Entity Type:Organization
Organization Name:BEACON FAMILY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:435-817-7147
Mailing Address - Street 1:8915 S 700 E
Mailing Address - Street 2:203
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2417
Mailing Address - Country:US
Mailing Address - Phone:801-938-5151
Mailing Address - Fax:
Practice Address - Street 1:8915 S 700 E
Practice Address - Street 2:SUITE 203
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2417
Practice Address - Country:US
Practice Address - Phone:801-938-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health