| Great Salt Lake Wellness Inc | |
|
375 N Main St Ste 202 Kaysville UT 84037-1278 | |
| (801) 844-1615 | |
| (801) 825-1162 |
| Full Name | Great Salt Lake Wellness Inc |
|---|---|
| Speciality | Psychologist |
| Location | 375 N Main St Ste 202, Kaysville, Utah |
| Authorized Official Name and Position | Emily Young Bullock (OWNER) |
| Authorized Official Contact | 8013899521 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Salt Lake Wellness Inc 375 N Main St Ste 202 Kaysville UT 84037-1278 Ph: (801) 844-1615 | Great Salt Lake Wellness Inc 375 N Main St Ste 202 Kaysville UT 84037-1278 Ph: (801) 844-1615 |
| NPI Number | 1790152940 |
|---|---|
| Provider Enumeration Date | 08/24/2015 |
| Last Update Date | 04/17/2024 |
| Certification Date | 04/17/2024 |
| Medicare PECOS PAC ID | 4789985680 |
|---|---|
| Medicare Enrollment ID | O20151218000873 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790152940 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 7510289-2501 (Utah) | Primary |
| Provider Name | Kirt Erik Cundick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629395181 PECOS PAC ID: 2062660764 Enrollment ID: I20120921000721 |
| Provider Name | Emily Y Bullock |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760670962 PECOS PAC ID: 3375777840 Enrollment ID: I20131016001404 |
| Provider Name | Jill Lynn Perry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073939807 PECOS PAC ID: 2769738863 Enrollment ID: I20180703001201 |
| Provider Name | Jeanne Marine Foster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922760594 PECOS PAC ID: 1254717861 Enrollment ID: I20221005002952 |
| Provider Name | Paige Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629662143 PECOS PAC ID: 8921474966 Enrollment ID: I20221017002661 |
| Provider Name | Angela Wignall Schultz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306425152 PECOS PAC ID: 4284080508 Enrollment ID: I20231023003309 |
| Provider Name | Carrie Moore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356893804 PECOS PAC ID: 3678919438 Enrollment ID: I20240314003216 |
| Provider Name | Tifany Barlow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902233950 PECOS PAC ID: 0840632121 Enrollment ID: I20240531003050 |
Kathryn Stewart, Ph.d. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 447 N 300 W, Suite 7, Kaysville, UT 84037 Phone: 801-544-7413 Fax: 801-544-3819 | |
Carbajal Counseling And Consulting, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 375 N Main St Ste 102, Kaysville, UT 84037 Phone: 801-989-3488 Fax: 801-989-5861 | |
Integrative Amd Holistic Center, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 375 N Main St Ste 202, Kaysville, UT 84037 Phone: 801-923-3290 | |
Healing Journey Counseling Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 475 N 300 W Ste 16, Kaysville, UT 84037 Phone: 385-381-2007 | |
Taylor And Taylor Consulting Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 459 N 300 W Ste 13, Kaysville, UT 84037 Phone: 801-337-9229 | |
Mountain West Psychology Services Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 265 N Main St Ste D173, Kaysville, UT 84037 Phone: 801-476-9616 Fax: 801-476-6990 | |
Hansann & Associates Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1470 S 500 E, Kaysville, UT 84037 Phone: 801-698-1160 |