Provider Demographics
NPI:1245687763
Name:SALT PSYCHOLOGICAL AND BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:SALT PSYCHOLOGICAL AND BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:THUESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-768-0608
Mailing Address - Street 1:9710 S 700 E
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3594
Mailing Address - Country:US
Mailing Address - Phone:801-768-0608
Mailing Address - Fax:
Practice Address - Street 1:9710 S 700 E
Practice Address - Street 2:SUITE 111
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3594
Practice Address - Country:US
Practice Address - Phone:801-768-0608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty