Provider Demographics
NPI:1811523202
Name:RISE ABOVE FORENSICS BEHAVIORAL ASSESSMENT AND COUNSELING LLC
Entity type:Organization
Organization Name:RISE ABOVE FORENSICS BEHAVIORAL ASSESSMENT AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-710-2440
Mailing Address - Street 1:339 E 3900 S STE 230A
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:339 E 3900 S STE 230A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2437
Practice Address - Country:US
Practice Address - Phone:801-710-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty