Provider Demographics
NPI:1982147377
Name:STRIVE MENTAL HEALTH
Entity Type:Organization
Organization Name:STRIVE MENTAL HEALTH
Other - Org Name:STRIVE BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-337-8277
Mailing Address - Street 1:2520 N UNIVERSITY AVE # 250
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3804
Mailing Address - Country:US
Mailing Address - Phone:801-337-8277
Mailing Address - Fax:801-812-8018
Practice Address - Street 1:2520 N UNIVERSITY AVE # 250
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3804
Practice Address - Country:US
Practice Address - Phone:801-337-8277
Practice Address - Fax:801-812-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10083905-01622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty