Provider Demographics
NPI:1295164408
Name:HEART SMITH RECOVERY
Entity type:Organization
Organization Name:HEART SMITH RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-263-6367
Mailing Address - Street 1:32 W WINCHESTER ST
Mailing Address - Street 2:101
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-263-6367
Mailing Address - Fax:801-263-6370
Practice Address - Street 1:32 W WINCHESTER ST
Practice Address - Street 2:101
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5607
Practice Address - Country:US
Practice Address - Phone:801-263-6367
Practice Address - Fax:801-263-6370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRAUMA AWARENESS AND TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT21266251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health