| Outpatient Behavioral Health | |
|
140 W 2100 S Ste 110 Salt Lake City UT 84115-1855 | |
| (801) 382-8259 | |
| Not Available |
| Full Name | Outpatient Behavioral Health |
|---|---|
| Speciality | Social Worker |
| Location | 140 W 2100 S Ste 110, Salt Lake City, Utah |
| Authorized Official Name and Position | Clifton R Uckerman (OWNER) |
| Authorized Official Contact | 8017078235 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Outpatient Behavioral Health 255 N 400 W Apt 2022 Salt Lake City UT 84103-1399 Ph: (801) 707-8235 | Outpatient Behavioral Health 140 W 2100 S Ste 110 Salt Lake City UT 84115-1855 Ph: (801) 382-8259 |
| NPI Number | 1326799941 |
|---|---|
| Provider Enumeration Date | 01/14/2022 |
| Last Update Date | 10/11/2023 |
| Certification Date | 10/11/2023 |
| Medicare PECOS PAC ID | 2668855420 |
|---|---|
| Medicare Enrollment ID | O20220811003429 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326799941 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | John L Walters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932488426 PECOS PAC ID: 0143493049 Enrollment ID: I20111108000824 |
| Provider Name | Clifton Rueben Uckerman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528362852 PECOS PAC ID: 6507083383 Enrollment ID: I20140819001667 |
| Provider Name | Shanna Lindstrom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770915712 PECOS PAC ID: 0042511396 Enrollment ID: I20151210002506 |
| Provider Name | Rebecca Nay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386241560 PECOS PAC ID: 5395102214 Enrollment ID: I20230608002159 |
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