| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 100 S 1000 W, Tooele, Utah |
| Authorized Official Name and Position | Debra Falvo (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8012637100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5965 S 900 E Suite 420 Salt Lake City UT 84121-1720 Ph: (801) 263-7100 | 100 S 1000 W Tooele UT 84074-4010 Ph: (435) 843-3520 |
| NPI Number | 1649236175 |
|---|---|
| Provider Enumeration Date | 04/24/2006 |
| Last Update Date | 08/25/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649236175 | NPI | - | NPPES |
| 2423 | Other | UT | PEHP |
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