University of Utah Pediatric Behavioral Health Services
Organization Active NPI Child & Adolescent Psychiatry Physician · Salt Lake City, UT
NPI 1174073746 · NPPES record last updated Oct 7, 2016
Key facts
- NPI
- 1174073746
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- Legal business name
- UNIVERSITY OF UTAH PEDIATRIC BEHAVIORAL HEALTH SERVICES
- Practice address
- 501 S Chipeta Way
Salt Lake City, UT 84108-1222 - Phone
- (801) 585-1575
- NPI assigned
- Oct 7, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- UNIVERSITY OF UTAH PEDIATRIC BEHAVIORAL HEALTH SERVICES
Authorized official
- Name
- Edward Clark, MD
- Title
- Department Chair
- Phone
- (801) 587-6336
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 11
Practitioners 7
-
Sonja J Bates, APRN
-
Celestia Buckley, PSY.D.
-
Thomas Lyle Gethin-Jones, M.D.
-
Emily Moulton Parker, PHD
-
Sarah Theo Porter, DNP, APRN, PMHNP
-
Deanna Lynn Reilly, PH.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160727002309 | UT | Part B Supplier - Clinic/Group Practice | 3870886898 |
Receives reassigned benefits from 119 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Salt Lake City, UT |
National Provider Directory
- Part of
- University of Utah Pediatric Behavioral Health Services
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician |
2084P0804X | Yes |
Addresses
Primary practice location
501 S Chipeta Way
Salt Lake City, UT 84108-1222
Mailing address
PO Box 413021
Salt Lake City, UT 84141-3021
Phone (801) 213-3900
Other names
- Pediatric Behavioral Health Outpatient Svcs
Other providers in Salt Lake City, UT
- University of Utah Pediatric Acuity Care
- University of Utah Pediatric Acuity Care
- University of Utah Pediatric Adolescent Professional Services
- University of Utah Pediatric Behavioral Health Services
- University of Utah Pediatric Behavioral Health Services
- University of Utah Pediatric Behavioral Health Services
- University of Utah Pediatric Behavioral Health Services
- University of Utah Pediatric Behavioral Health Services
- University of Utah Pediatric Behavioral Health Services
- University of Utah Pediatric Behavioral Health Services
All providers in Salt Lake City, UT · Child & Adolescent Psychiatry Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.