Provider Demographics
NPI:1184790370
Name:BEHAVIORAL HEALTH ASSOCIATES OF UTAH LLC
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH ASSOCIATES OF UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-580-9192
Mailing Address - Street 1:108 N MAIN ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2168
Mailing Address - Country:US
Mailing Address - Phone:435-896-5165
Mailing Address - Fax:435-578-8008
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:SUITE I
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2168
Practice Address - Country:US
Practice Address - Phone:435-896-5165
Practice Address - Fax:435-578-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1022722501103T00000X
UT368809-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT148271300OtherDEPT OF LABOR OWCP
UT24703OtherPEHP PREFERRED PROVIDER