OrganizationActive
Trauma Center of Utah, LLC
NPI 1295207231 · Adolescent and Children Mental Health Clinic/Center · Provo, UT
Provider details
- NPI number
- 1295207231
- Entity type
- Organization
- Primary specialty
- Adolescent and Children Mental Health Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Tonya Porter, Clinical Director(801) 851-5504
Specialties & taxonomies
Ambulatory Health Care Facilities
Behavioral Health & Social Service Providers
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
Allopathic & Osteopathic Physicians
- Psychiatry Physician2084P0800X
Allopathic & Osteopathic Physicians
- Child & Adolescent Psychiatry Physician2084P0804X
Allopathic & Osteopathic Physicians
Practice location
4980 N University Ave Apt 12
Provo, UT 84604-6444
Phone: (801) 644-4014
Approximate (ZIP-level) locationGet directions
Mailing address
4980 N University Ave Apt 12
Provo, UT 84604-6444
Registry dates
- Enumerated
- 2018-12-31
- Last updated
- 2018-12-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.