| Trauma Awareness & Treatment Center, Inc. | |
|
32 W Winchester St Suite 101 Salt Lake City UT 84107-5607 | |
| (801) 263-6367 | |
| (801) 263-6370 |
| Full Name | Trauma Awareness & Treatment Center, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 32 W Winchester St, Salt Lake City, Utah |
| Authorized Official Name and Position | Lawrence Dalton Beall (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8012636367 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trauma Awareness & Treatment Center, Inc. 32 W Winchester St Suite 101 Salt Lake City UT 84107-5607 Ph: (801) 263-6367 | Trauma Awareness & Treatment Center, Inc. 32 W Winchester St Suite 101 Salt Lake City UT 84107-5607 Ph: (801) 263-6367 |
| NPI Number | 1770542219 |
|---|---|
| Provider Enumeration Date | 03/22/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8325078306 |
|---|---|
| Medicare Enrollment ID | O20050818001076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770542219 | NPI | - | NPPES |
| 788007788591 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 10844 (Utah) | Primary |
| Provider Name | Heather A Whitehead-sampinos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356301154 PECOS PAC ID: 1456476449 Enrollment ID: I20100914001055 |
| Provider Name | Jeness L Woodard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881031771 PECOS PAC ID: 2668616814 Enrollment ID: I20130910000493 |
| Provider Name | Tamara Lin Vitela |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285842435 PECOS PAC ID: 6800954066 Enrollment ID: I20141002000422 |
| Provider Name | Lindsey Ann Macfarlane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205154978 PECOS PAC ID: 6709178692 Enrollment ID: I20160713002472 |
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