| Assauge | |
|
1537 S Main St Salt Lake City UT 84115-5315 | |
| (435) 720-8338 | |
| Not Available |
| Full Name | Assauge |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1537 S Main St, Salt Lake City, Utah |
| Authorized Official Name and Position | Peter Conder (OWNER) |
| Authorized Official Contact | 4357208338 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Assauge 1537 S Main St Salt Lake City UT 84115-5315 Ph: (435) 720-8338 | Assauge 1537 S Main St Salt Lake City UT 84115-5315 Ph: (435) 720-8338 |
| NPI Number | 1053084434 |
|---|---|
| Provider Enumeration Date | 07/30/2021 |
| Last Update Date | 07/30/2021 |
| Certification Date | 07/30/2021 |
| Medicare PECOS PAC ID | 5597103135 |
|---|---|
| Medicare Enrollment ID | O20240402002813 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053084434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Peter Bryan Conder |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710367610 PECOS PAC ID: 0941648588 Enrollment ID: I20240402002877 |
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