| Ipsse | |
|
352 S Denver St Ste 315 Salt Lake City UT 84111-3054 | |
| (801) 520-7938 | |
| (800) 528-1208 |
| Full Name | Ipsse |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 352 S Denver St Ste 315, Salt Lake City, Utah |
| Authorized Official Name and Position | Joseph R. Gouveia-grant (CLINICIAN) |
| Authorized Official Contact | 8015207938 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ipsse Po Box 508 Salt Lake City UT 84110-0508 Ph: (801) 520-7938 | Ipsse 352 S Denver St Ste 315 Salt Lake City UT 84111-3054 Ph: (801) 520-7938 |
| NPI Number | 1760037675 |
|---|---|
| Provider Enumeration Date | 08/07/2019 |
| Last Update Date | 07/20/2021 |
| Certification Date | 07/20/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760037675 | NPI | - | NPPES |
| 1790125730 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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