Provider Demographics
NPI:1669067633
Name:PATTERNS BEHAVIORAL SERVICES UTAH, INC.
Entity type:Organization
Organization Name:PATTERNS BEHAVIORAL SERVICES UTAH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-444-9002
Mailing Address - Street 1:19217 36TH AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5751
Mailing Address - Country:US
Mailing Address - Phone:360-202-2554
Mailing Address - Fax:
Practice Address - Street 1:19217 36TH AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:657-444-9002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty