Provider Demographics
NPI:1295792117
Name:VALLEY MENTAL HEALTH INCORPORATED
Entity type:Organization
Organization Name:VALLEY MENTAL HEALTH INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARCENAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-263-7100
Mailing Address - Street 1:5965 S 900 E
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1720
Mailing Address - Country:US
Mailing Address - Phone:801-263-7100
Mailing Address - Fax:801-263-7123
Practice Address - Street 1:4460 HIGHLAND DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3543
Practice Address - Country:US
Practice Address - Phone:801-273-6366
Practice Address - Fax:801-273-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT104100000X, 1041C0700X, 101YP2500X, 101YM0800X, 163WC0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========014MedicaidCAPITATED MEDICAID
UT=========014Medicaid
UT=========014MedicaidCAPITATED MEDICAID