| Fully Integrative | |
|
756 E 500 S Salt Lake City UT 84102-2906 | |
| (435) 590-0116 | |
| Not Available |
| Full Name | Fully Integrative |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 756 E 500 S, Salt Lake City, Utah |
| Authorized Official Name and Position | Jacob Stucki (CEO) |
| Authorized Official Contact | 4355900116 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fully Integrative 756 E 500 S Salt Lake City UT 84102-2906 Ph: (435) 590-0116 | Fully Integrative 756 E 500 S Salt Lake City UT 84102-2906 Ph: (435) 590-0116 |
| NPI Number | 1770294720 |
|---|---|
| Provider Enumeration Date | 12/12/2022 |
| Last Update Date | 12/12/2022 |
| Certification Date | 12/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770294720 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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