Dr Brandon J Wilde, CMHC | |
122 E 1700 S Bldg 3, Provo, UT 84606-5644 | |
(801) 900-3656 | |
Not Available |
Full Name | Dr Brandon J Wilde |
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Gender | Male |
Speciality | Counselor - Mental Health |
Location | 122 E 1700 S Bldg 3, Provo, Utah |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1710140447 | NPI | - | NPPES |
807197600 | Medicaid | ID | |
4290476 | Medicaid | UT |
Entity Name | Rocky Mountain University Of Health Professions Foundation |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1053174417 PECOS PAC ID: 7810439130 Enrollment ID: O20240603000185 |
Mailing Address | Practice Location Address |
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Dr Brandon J Wilde, CMHC 7897 N Broken Arrow Ln, Eagle Mountain, UT 84005-7203 Ph: (602) 460-6428 | Dr Brandon J Wilde, CMHC 122 E 1700 S Bldg 3, Provo, UT 84606-5644 Ph: (801) 900-3656 |
Susan Easton Black, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1190 N 900 E, Provo, UT 84604 Phone: 801-422-7620 Fax: 801-422-0165 | |
Daniel Howell, Counselor Medicare: Not Enrolled in Medicare Practice Location: 619 N 500 W, Provo, UT 84601 Phone: 801-375-4240 Fax: 801-375-4241 | |
Vicki Goodman, Counselor Medicare: Not Enrolled in Medicare Practice Location: 619 N 500 W, Provo, UT 84601 Phone: 801-420-0465 Fax: 801-375-4241 | |
Colbey Bentley, Counselor Medicare: Not Enrolled in Medicare Practice Location: 717 N 1850 W, Provo, UT 84604 Phone: 801-375-4240 Fax: 801-375-4241 | |
Maurhy Alfredo Meneses, Counselor Medicare: Not Enrolled in Medicare Practice Location: 836 N 1375 W, Provo, UT 84604 Phone: 801-375-2523 Fax: 801-375-2523 | |
David Skiles, CMHC Counselor Medicare: Medicare Enrolled Practice Location: 750 N Freedom Blvd, Provo, UT 84601 Phone: 801-373-4760 Fax: 801-373-0639 | |
Scott D Owen, PH.D. Counselor Medicare: Not Enrolled in Medicare Practice Location: 3651 N 100 E Ste 100, Provo, UT 84604 Phone: 801-356-0014 Fax: 801-373-3655 |