Provider Demographics
NPI:1710217864
Name:INNER SPECTRUMS, INC.
Entity Type:Organization
Organization Name:INNER SPECTRUMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAWS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-341-8218
Mailing Address - Street 1:2735 DOUBLE EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6526
Mailing Address - Country:US
Mailing Address - Phone:801-341-8218
Mailing Address - Fax:801-341-8218
Practice Address - Street 1:3051 W MAPLE LOOP DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5621
Practice Address - Country:US
Practice Address - Phone:801-341-8218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5661581-3501302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization