| Utah Pride Center | |
|
255 E 400 S Salt Lake City UT 84111-2846 | |
| (801) 539-8800 | |
| Not Available |
| Full Name | Utah Pride Center |
|---|---|
| Speciality | Counselor |
| Location | 255 E 400 S, Salt Lake City, Utah |
| Authorized Official Name and Position | Steven Ha (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8018701794 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Utah Pride Center Po Box 1078 Salt Lake City UT 84110-1078 Ph: (801) 539-8800 | Utah Pride Center 255 E 400 S Salt Lake City UT 84111-2846 Ph: (801) 539-8800 |
| NPI Number | 1154745693 |
|---|---|
| Provider Enumeration Date | 02/04/2014 |
| Last Update Date | 02/04/2014 |
| Medicare PECOS PAC ID | 1850514506 |
|---|---|
| Medicare Enrollment ID | O20140527000988 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154745693 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Joshua Bravo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043635097 PECOS PAC ID: 7618195876 Enrollment ID: I20140829000858 |
| Provider Name | Jack Davis Haden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821396540 PECOS PAC ID: 5698152510 Enrollment ID: I20220516001354 |
| Provider Name | Michelle Anklan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003413964 PECOS PAC ID: 7810374311 Enrollment ID: I20220524000172 |
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