Provider Demographics
NPI:1790306652
Name:PINNACLE ADDICTION & MENTAL HEALTH THERAPY
Entity Type:Organization
Organization Name:PINNACLE ADDICTION & MENTAL HEALTH THERAPY
Other - Org Name:PINNACLE ADDICTION AVE. & MENTAL HEALTH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-842-8062
Mailing Address - Street 1:5108 W EAGLE HILL CIR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3989
Mailing Address - Country:US
Mailing Address - Phone:801-842-8062
Mailing Address - Fax:
Practice Address - Street 1:3507 N UNIVERSITY AVE # 375C
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4478
Practice Address - Country:US
Practice Address - Phone:801-842-8062
Practice Address - Fax:801-305-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty