| Unconventional Llc | |
|
2901 W Blue Grass Blvd Ste 200 Lehi UT 84043-4190 | |
| (435) 557-4355 | |
| Not Available |
| Full Name | Unconventional Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2901 W Blue Grass Blvd Ste 200, Lehi, Utah |
| Authorized Official Name and Position | Martie Tamashiro (OWNER) |
| Authorized Official Contact | 8018570102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Unconventional Llc 2901 W Blue Grass Blvd Ste 200 Lehi UT 84043-4190 Ph: (435) 557-4355 | Unconventional Llc 2901 W Blue Grass Blvd Ste 200 Lehi UT 84043-4190 Ph: (435) 557-4355 |
| NPI Number | 1639820285 |
|---|---|
| Provider Enumeration Date | 01/14/2022 |
| Last Update Date | 01/14/2022 |
| Certification Date | 01/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639820285 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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