Provider Demographics
NPI:1942693213
Name:PAIUTE INDIAN TRIBE OF UTAH
Entity Type:Organization
Organization Name:PAIUTE INDIAN TRIBE OF UTAH
Other - Org Name:PITU BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BEHAVIORAL CARE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-586-1112
Mailing Address - Street 1:440 N PAIUTE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-6181
Mailing Address - Country:US
Mailing Address - Phone:435-586-1112
Mailing Address - Fax:435-867-1516
Practice Address - Street 1:440 N PAIUTE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-6181
Practice Address - Country:US
Practice Address - Phone:435-586-1112
Practice Address - Fax:435-867-1516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIUTE INDIAN TRIBE OF UTAH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-11
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12346251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health