Provider Demographics
NPI:1265263818
Name:BOX ELDER MENTAL HEALTH
Entity type:Organization
Organization Name:BOX ELDER MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-910-9412
Mailing Address - Street 1:791 N 2300 W
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-9331
Mailing Address - Country:US
Mailing Address - Phone:801-910-9412
Mailing Address - Fax:
Practice Address - Street 1:791 N 2300 W
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-9331
Practice Address - Country:US
Practice Address - Phone:801-910-9412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health