Provider Demographics
NPI:1659577476
Name:CLINICAL CONSULTANTS
Entity Type:Organization
Organization Name:CLINICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:LSAC
Authorized Official - Phone:801-233-8670
Mailing Address - Street 1:2351 GRANT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1406
Mailing Address - Country:US
Mailing Address - Phone:801-621-8670
Mailing Address - Fax:801-621-4512
Practice Address - Street 1:2351 GRANT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1406
Practice Address - Country:US
Practice Address - Phone:801-621-8670
Practice Address - Fax:801-621-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12931251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health