Basic Information
| Provider Information | |||||||||
| NPI: | 1841486016 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY MENTAL HEALTH INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5965 S 900 E | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841211720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012637100 | ||||||||
| FaxNumber: | 8012637123 | ||||||||
| Practice Location | |||||||||
| Address1: | 1724 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841151912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014865012 | ||||||||
| FaxNumber: | 8014665077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 08/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | FALVO | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8012637100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MHSA/RNC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.