Provider Demographics
NPI:1487908968
Name:UNIVERSITY NEUROPSYCHIATRIC INSTITUE
Entity type:Organization
Organization Name:UNIVERSITY NEUROPSYCHIATRIC INSTITUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENTZSCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-236-7110
Mailing Address - Street 1:252 SOUTH 500 EAST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2030
Mailing Address - Country:US
Mailing Address - Phone:801-236-7710
Mailing Address - Fax:
Practice Address - Street 1:252 SOUTH 500 EAST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2030
Practice Address - Country:US
Practice Address - Phone:801-236-7710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility