Provider Demographics
NPI:1245371699
Name:U-U ALCOHOL & DRUG CLINIC SCHOOL OF MEDICINE
Entity type:Organization
Organization Name:U-U ALCOHOL & DRUG CLINIC SCHOOL OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-581-6228
Mailing Address - Street 1:30 N 1900 E
Mailing Address - Street 2:1R52 SOM
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-2119
Mailing Address - Country:US
Mailing Address - Phone:801-581-6228
Mailing Address - Fax:801-585-6702
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:1R52 SOM
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2119
Practice Address - Country:US
Practice Address - Phone:801-581-6228
Practice Address - Fax:801-585-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12188103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty