| Authenticity Utah Pllc | |
|
2265 S State St Apt 272 South Salt Lake UT 84115-1405 | |
| (435) 720-8338 | |
| Not Available |
| Full Name | Authenticity Utah Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2265 S State St Apt 272, South Salt Lake, Utah |
| Authorized Official Name and Position | Peter Bryan Conder (FOUNDER) |
| Authorized Official Contact | 4357208338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Authenticity Utah Pllc 2265 S State St Apt 272 South Salt Lake UT 84115-1405 Ph: (435) 720-8338 | Authenticity Utah Pllc 2265 S State St Apt 272 South Salt Lake UT 84115-1405 Ph: (435) 720-8338 |
| NPI Number | 1477175560 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 05/11/2020 |
| Certification Date | 05/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477175560 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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