Basic Information
| Provider Information | |||||||||
| NPI: | 1912242918 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AFFINITY BEHAVIOR AND MENTAL HEALTH SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13923 S HAYSTACK PEAK CIR | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840966453 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 13923 S HAYSTACK PEAK CIR | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840966453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015980743 | ||||||||
| FaxNumber: | 8016067445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2012 | ||||||||
| LastUpdateDate: | 12/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | NAYLOR | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8015980743 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.