Unknown Individual – Psychiatry Physician, NPI 1740259795

Unknown Individual is a healthcare provider. based in Salt lake city, Utah. specializing in Psychiatry Physician. They hold a License No. 156060-1205 (UT). The NPI Number for Unknown Individual is 1740259795

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1740259795
Phone
(801) 467-1200
Address
1522S 1100 E
Deactivation Date
29 June 2022

Doctor Profile

Medical School Name
CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY
Secondary Phone
8014671200
Graduation Year
1972 (54 years ago)
PAC ID
6608973391
Group Practice PAC ID
8921245879
Professional Enrollment ID
I20070514000505
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 1522S 1100 E

    SALT LAKE CITY, UT 841052425

    Phone: (801) 467-1200

    Fax: (801) 467-1210

    Type: Location

  • 1522, 1100 East, East Liberty Park, Salt Lake City, Salt Lake County, Utah, 84105, United States

    PSYCHIATRIC & BEHAVIORAL SOLUTIONS

    SALT LAKE CITY, UT 84105

    Phone: (801) 467-1200

    Fax: (801) 467-1210

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 84105)

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Provider's Procedures

Unknown Individual performs procedures in Psychiatry Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PSYCHIATRYUT90833Psychotherapy, 30 minutes with patient and/or family member12139

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8921245879View full group profile
NameSpecialtyState
P S Y C H I A T R YUT
Nurse PractitionerUT
Clinical Social WorkerUT
Nurse PractitionerUT

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1740259795 — the number used across U.S. healthcare to identify this provider.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Where in Utah is Unknown Individual registered?
Use Salt Lake City, Utah as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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