| Bonneville Mental Health, Pllc | |
|
134 W 1180 N Ste 4 Tooele UT 84074-1483 | |
| (435) 228-4181 | |
| Not Available |
| Full Name | Bonneville Mental Health, Pllc |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 134 W 1180 N Ste 4, Tooele, Utah |
| Authorized Official Name and Position | Nate Green (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 4352284181 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bonneville Mental Health, Pllc 134 W 1180 N Ste 4 Tooele UT 84074-1483 Ph: (435) 228-4181 | Bonneville Mental Health, Pllc 134 W 1180 N Ste 4 Tooele UT 84074-1483 Ph: (435) 228-4181 |
| NPI Number | 1902236458 |
|---|---|
| Provider Enumeration Date | 11/20/2013 |
| Last Update Date | 05/10/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902236458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 2903 (Utah) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 2903 (Utah) | Primary |
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