| Center For Growth & Potential | |
|
1148 W Legacy Crossing Blvd Ste 130 Centerville UT 84014-5537 | |
| (801) 773-0535 | |
| (801) 773-0536 |
| Full Name | Center For Growth & Potential |
|---|---|
| Speciality | Counselor |
| Location | 1148 W Legacy Crossing Blvd Ste 130, Centerville, Utah |
| Authorized Official Name and Position | Mandi Mccoy (OFFICE MANAGER) |
| Authorized Official Contact | 8017730535 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Growth & Potential 1148 W Legacy Crossing Blvd Ste 130 Centerville UT 84014-5537 Ph: (801) 773-0535 | Center For Growth & Potential 1148 W Legacy Crossing Blvd Ste 130 Centerville UT 84014-5537 Ph: (801) 773-0535 |
| NPI Number | 1265846976 |
|---|---|
| Provider Enumeration Date | 06/20/2014 |
| Last Update Date | 03/21/2023 |
| Certification Date | 03/21/2023 |
| Medicare PECOS PAC ID | 1850669094 |
|---|---|
| Medicare Enrollment ID | O20170613000595 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265846976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 3454712501 (Utah) | Primary |
| Provider Name | Maya E Gentry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609009216 PECOS PAC ID: 6608822374 Enrollment ID: I20050324001264 |
| Provider Name | Karolee Alexander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962635672 PECOS PAC ID: 1557491222 Enrollment ID: I20100608000238 |
| Provider Name | John D Perovich |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427105493 PECOS PAC ID: 7810265055 Enrollment ID: I20170515000841 |
| Provider Name | Kathleen G Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578910725 PECOS PAC ID: 0143633214 Enrollment ID: I20210108002349 |
| Provider Name | Alana Jacobs-davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457380818 PECOS PAC ID: 7416351705 Enrollment ID: I20210809002876 |
| Provider Name | Corey S Gunsolley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255703666 PECOS PAC ID: 2264820117 Enrollment ID: I20211026000187 |
| Provider Name | Brian Tyler Melville |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982085718 PECOS PAC ID: 6204145733 Enrollment ID: I20220113002527 |
| Provider Name | Russell H Peterson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093879637 PECOS PAC ID: 6204270978 Enrollment ID: I20240221001874 |
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