Provider Demographics
NPI:1679961346
Name:BARBARA SCOVILLE LLC
Entity Type:Organization
Organization Name:BARBARA SCOVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-910-5385
Mailing Address - Street 1:5635 S WATERBURY WAY
Mailing Address - Street 2:C202
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1184
Mailing Address - Country:US
Mailing Address - Phone:801-278-0200
Mailing Address - Fax:801-273-0322
Practice Address - Street 1:5635 S WATERBURY WAY
Practice Address - Street 2:C202
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1184
Practice Address - Country:US
Practice Address - Phone:801-278-0200
Practice Address - Fax:801-273-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U000076155Medicare UPIN