Provider Demographics
NPI:1912242918
Name:AFFINITY BEHAVIOR AND MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:AFFINITY BEHAVIOR AND MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-598-0743
Mailing Address - Street 1:13923 S HAYSTACK PEAK CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13923 S HAYSTACK PEAK CIR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6453
Practice Address - Country:US
Practice Address - Phone:801-598-0743
Practice Address - Fax:801-606-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health