| College Of Nursing, Mental Health Services | |
|
50 N Medical Dr Salt Lake City UT 84132-0001 | |
| (801) 581-2121 | |
| Not Available |
| Full Name | College Of Nursing, Mental Health Services |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 50 N Medical Dr, Salt Lake City, Utah |
| Authorized Official Name and Position | Samuel Finlayson (CHIEF CLINICAL OFFICER) |
| Authorized Official Contact | 8015876336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| College Of Nursing, Mental Health Services Po Box 841450 Los Angeles CA 90084-1450 Ph: (801) 213-3900 | College Of Nursing, Mental Health Services 50 N Medical Dr Salt Lake City UT 84132-0001 Ph: (801) 581-2121 |
| NPI Number | 1740688613 |
|---|---|
| Provider Enumeration Date | 12/09/2014 |
| Last Update Date | 01/22/2021 |
| Certification Date | 01/22/2021 |
| Medicare PECOS PAC ID | 9537483607 |
|---|---|
| Medicare Enrollment ID | O20150120001118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740688613 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Paula K Gibbs |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396754495 PECOS PAC ID: 3678487949 Enrollment ID: I20031119000607 |
| Provider Name | Deborah A Bilder |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427084615 PECOS PAC ID: 3870493067 Enrollment ID: I20040113000241 |
| Provider Name | Philip L Baese |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184669848 PECOS PAC ID: 7618878299 Enrollment ID: I20040116000334 |
| Provider Name | Roxanne L Bartel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104903897 PECOS PAC ID: 7911990924 Enrollment ID: I20040406000644 |
| Provider Name | Jason W Hunziker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619067212 PECOS PAC ID: 7416941612 Enrollment ID: I20040412000695 |
| Provider Name | Sandra L Whitehouse |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821055377 PECOS PAC ID: 1355336348 Enrollment ID: I20040419000919 |
| Provider Name | David Gary Eldredge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699758342 PECOS PAC ID: 6406846054 Enrollment ID: I20040514001062 |
| Provider Name | James C Ashworth |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1679514988 PECOS PAC ID: 6901883701 Enrollment ID: I20040630000397 |
| Provider Name | Susan Saffel-shrier |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1740370360 PECOS PAC ID: 3072591411 Enrollment ID: I20040712000612 |
| Provider Name | Mark A Rindflesh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710944293 PECOS PAC ID: 1456326529 Enrollment ID: I20040901000181 |
| Provider Name | Amanda M Weeks |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295791234 PECOS PAC ID: 7810953072 Enrollment ID: I20041208001211 |
| Provider Name | Isabella O H Tcaciuc |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245201870 PECOS PAC ID: 3072561224 Enrollment ID: I20050105000272 |
| Provider Name | Michelle M Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427196849 PECOS PAC ID: 3072563956 Enrollment ID: I20050127001122 |
| Provider Name | Barbara Faust |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710920566 PECOS PAC ID: 2163473166 Enrollment ID: I20050208000203 |
| Provider Name | Scott M Smid |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780799973 PECOS PAC ID: 7214989607 Enrollment ID: I20050214000758 |
| Provider Name | Kelly J Lundberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669562278 PECOS PAC ID: 3678525789 Enrollment ID: I20050217000227 |
| Provider Name | Brad L Murray |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225122187 PECOS PAC ID: 3577510239 Enrollment ID: I20050405000494 |
| Provider Name | Kristi Kay Kleinschmit |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689772741 PECOS PAC ID: 2668411083 Enrollment ID: I20050426000696 |
| Provider Name | Elizabeth F Howell |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1326052440 PECOS PAC ID: 2567404452 Enrollment ID: I20050601001027 |
| Provider Name | Matthew M Woolley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871691956 PECOS PAC ID: 8729016639 Enrollment ID: I20050802000295 |
| Provider Name | Thomas G Conover |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093805228 PECOS PAC ID: 5799715918 Enrollment ID: I20050817000802 |
| Provider Name | Sonja J Bates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699868950 PECOS PAC ID: 1254350739 Enrollment ID: I20051114000899 |
| Provider Name | Michael R Lowry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932116662 PECOS PAC ID: 4688697493 Enrollment ID: I20060107000018 |
| Provider Name | Mark Mottonen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861653784 PECOS PAC ID: 2163445982 Enrollment ID: I20060107000085 |
| Provider Name | Paul Douglas Thielking |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1124036595 PECOS PAC ID: 7416848007 Enrollment ID: I20060114000051 |
| Provider Name | Steven D Edwards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457331605 PECOS PAC ID: 5395753776 Enrollment ID: I20060327000451 |
| Provider Name | Matthew L Moench |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376641456 PECOS PAC ID: 5193725745 Enrollment ID: I20070104000089 |
| Provider Name | Laura A Czajkowski |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417047002 PECOS PAC ID: 0042312902 Enrollment ID: I20070222000758 |
| Provider Name | Douglas G Kondo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1083703284 PECOS PAC ID: 9739142332 Enrollment ID: I20070309000269 |
| Provider Name | Wade Osmond Milne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508843467 PECOS PAC ID: 9234234733 Enrollment ID: I20070411000370 |
| Provider Name | Deanna L Reilly |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649249731 PECOS PAC ID: 4789780156 Enrollment ID: I20070501000301 |
| Provider Name | Patricia L Galbraith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700992963 PECOS PAC ID: 1254438138 Enrollment ID: I20070530000261 |
| Provider Name | Richard S Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205800737 PECOS PAC ID: 9830297043 Enrollment ID: I20070612000736 |
| Provider Name | Joel S Dario |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275547507 PECOS PAC ID: 8123119419 Enrollment ID: I20070731000588 |
| Provider Name | Katherine P Supiano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548321763 PECOS PAC ID: 2769578277 Enrollment ID: I20071015000230 |
| Provider Name | Ligia J Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013174317 PECOS PAC ID: 6406929603 Enrollment ID: I20080722000143 |
| Provider Name | Jodi Morstein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942488002 PECOS PAC ID: 4284708082 Enrollment ID: I20080728000508 |
| Provider Name | Paul J Carlson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962515643 PECOS PAC ID: 3577515683 Enrollment ID: I20080917000024 |
| Provider Name | Michael J Voss |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790985992 PECOS PAC ID: 1850438185 Enrollment ID: I20091019000703 |
| Provider Name | Kevin M Duff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295720969 PECOS PAC ID: 0143278457 Enrollment ID: I20091023000387 |
| Provider Name | Duy Pham |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1346404233 PECOS PAC ID: 4385782697 Enrollment ID: I20091106000180 |
| Provider Name | Rachele M Mccarthey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700933538 PECOS PAC ID: 0547309528 Enrollment ID: I20091204000099 |
| Provider Name | Rachel A Weir |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1487779955 PECOS PAC ID: 5890822654 Enrollment ID: I20100427000621 |
| Provider Name | Howard R Weeks |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760570915 PECOS PAC ID: 4587788625 Enrollment ID: I20100826000679 |
| Provider Name | Joseph Michael Mcintosh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376633982 PECOS PAC ID: 1850416009 Enrollment ID: I20100913000331 |
| Provider Name | Benjamin R Chan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1952528374 PECOS PAC ID: 9133245590 Enrollment ID: I20100923000491 |
| Provider Name | Kalyani Samudra |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1528035748 PECOS PAC ID: 1850417619 Enrollment ID: I20100929000882 |
| Provider Name | Michelle M Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386729077 PECOS PAC ID: 0941493381 Enrollment ID: I20101019000228 |
| Provider Name | Akiko Okifuji |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386723856 PECOS PAC ID: 0244423184 Enrollment ID: I20101022001173 |
| Provider Name | Clark W Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487706099 PECOS PAC ID: 8729166285 Enrollment ID: I20110314000988 |
| Provider Name | Martin Freimer |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1902962293 PECOS PAC ID: 5597742171 Enrollment ID: I20110512000834 |
| Provider Name | Tiffani Dawn Morgan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437308681 PECOS PAC ID: 0648458026 Enrollment ID: I20110707000549 |
| Provider Name | Paul S Carbone |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1194796201 PECOS PAC ID: 2668642745 Enrollment ID: I20110829000128 |
| Provider Name | Caralee C Cumming |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154633691 PECOS PAC ID: 1153591094 Enrollment ID: I20110831000631 |
| Provider Name | Susan E Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295044170 PECOS PAC ID: 9133399017 Enrollment ID: I20110901000328 |
| Provider Name | Anne G Lin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790883874 PECOS PAC ID: 9638141138 Enrollment ID: I20110913000009 |
| Provider Name | Lisa M Ord |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831155621 PECOS PAC ID: 3476726290 Enrollment ID: I20111022000078 |
| Provider Name | Mary E Steinmann |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1386828606 PECOS PAC ID: 8729251921 Enrollment ID: I20111103000731 |
| Provider Name | L Kristin Shadow |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922028497 PECOS PAC ID: 0345408571 Enrollment ID: I20120220000836 |
| Provider Name | Melissa Cheng |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1518112358 PECOS PAC ID: 8729248216 Enrollment ID: I20120320000684 |
| Provider Name | Katherine Fortenberry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982902185 PECOS PAC ID: 5496915787 Enrollment ID: I20120323000225 |
| Provider Name | Ernest J Kendrick |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1306020375 PECOS PAC ID: 6709032873 Enrollment ID: I20120804000128 |
| Provider Name | David L Moulton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558332353 PECOS PAC ID: 4486654092 Enrollment ID: I20120814000422 |
| Provider Name | Kyle B Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568697241 PECOS PAC ID: 0042466609 Enrollment ID: I20120814000459 |
| Provider Name | Imran Mohammad Raja |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649424409 PECOS PAC ID: 1850549486 Enrollment ID: I20120924000447 |
| Provider Name | Britt F Holmes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467612689 PECOS PAC ID: 9335398791 Enrollment ID: I20121001000154 |
| Provider Name | Benjamin R Lewis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043455025 PECOS PAC ID: 6709035645 Enrollment ID: I20121009000362 |
| Provider Name | Jennifer G Odonohoe |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1811141500 PECOS PAC ID: 1850542119 Enrollment ID: I20121114000093 |
| Provider Name | Leeanne M Hess |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477805372 PECOS PAC ID: 7719139633 Enrollment ID: I20121128000472 |
| Provider Name | Scott D Hill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962845271 PECOS PAC ID: 6305084013 Enrollment ID: I20130607000113 |
| Provider Name | Sheila A Deyette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881038933 PECOS PAC ID: 4385885730 Enrollment ID: I20130726000456 |
| Provider Name | Amanda R Cornelius |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417287913 PECOS PAC ID: 2264674183 Enrollment ID: I20130806000292 |
| Provider Name | Kristin C Francis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912157249 PECOS PAC ID: 6406902154 Enrollment ID: I20130823001006 |
| Provider Name | Jeness L Woodard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881031771 PECOS PAC ID: 2668616814 Enrollment ID: I20130910000493 |
| Provider Name | Zoe A Robbins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134321508 PECOS PAC ID: 6507090800 Enrollment ID: I20130927000285 |
| Provider Name | Allsion M Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134566904 PECOS PAC ID: 5890922819 Enrollment ID: I20131219001531 |
| Provider Name | Michelle L Vo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053558825 PECOS PAC ID: 6800025495 Enrollment ID: I20140130001036 |
| Provider Name | Amy S Smith |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508917048 PECOS PAC ID: 9830364660 Enrollment ID: I20140324001427 |
| Provider Name | Patrick William Shea |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629203104 PECOS PAC ID: 8426280868 Enrollment ID: I20140612000745 |
| Provider Name | Tanya Maile Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366495459 PECOS PAC ID: 2264657295 Enrollment ID: I20140708001813 |
| Provider Name | Christina M Derbidge |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023423381 PECOS PAC ID: 7810116597 Enrollment ID: I20140910002389 |
| Provider Name | Jessica Z Howsley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366768251 PECOS PAC ID: 9830318104 Enrollment ID: I20140918000999 |
| Provider Name | Sara M Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760891634 PECOS PAC ID: 1254552045 Enrollment ID: I20141020002197 |
| Provider Name | Amy Wilson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427200898 PECOS PAC ID: 1052543808 Enrollment ID: I20141205002148 |
| Provider Name | Matthew Pierson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356584213 PECOS PAC ID: 8325362866 Enrollment ID: I20150112000263 |
| Provider Name | Elizabeth Botts |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124262886 PECOS PAC ID: 1850615568 Enrollment ID: I20150128000537 |
| Provider Name | Randi Hollis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346642121 PECOS PAC ID: 2769707256 Enrollment ID: I20150204000008 |
| Provider Name | Kamile M Weischedel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225327927 PECOS PAC ID: 8426275710 Enrollment ID: I20150529000924 |
| Provider Name | Brent M Kious |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952690919 PECOS PAC ID: 8628200466 Enrollment ID: I20150603002760 |
| Provider Name | Stamatios George Manolakas Dentino |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689963068 PECOS PAC ID: 5193944056 Enrollment ID: I20150605002872 |
| Provider Name | Wilbur Rigel Dattilo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003107483 PECOS PAC ID: 8820309826 Enrollment ID: I20150617001683 |
| Provider Name | Jeremy Thueson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902125032 PECOS PAC ID: 7214249671 Enrollment ID: I20150629000819 |
| Provider Name | Natalie Buerger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346637881 PECOS PAC ID: 8628382421 Enrollment ID: I20150807013876 |
| Provider Name | Jeremy Footer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740545672 PECOS PAC ID: 3678880283 Enrollment ID: I20150915001250 |
| Provider Name | Brian Mickey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306981709 PECOS PAC ID: 2769547462 Enrollment ID: I20151002000514 |
| Provider Name | Sara Callister |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083098917 PECOS PAC ID: 6305155540 Enrollment ID: I20151029000251 |
| Provider Name | Sydney Abbott |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1528444569 PECOS PAC ID: 2668782095 Enrollment ID: I20151113001832 |
| Provider Name | Julio Jarvis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821394842 PECOS PAC ID: 8123323326 Enrollment ID: I20160225002379 |
| Provider Name | Sarah Wetmore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962754267 PECOS PAC ID: 3375833585 Enrollment ID: I20160531001872 |
| Provider Name | Theresa Lynn Limberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457716185 PECOS PAC ID: 8224329388 Enrollment ID: I20160620002396 |
| Provider Name | Stephen Trapp |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659622124 PECOS PAC ID: 0547551384 Enrollment ID: I20160624001140 |
| Provider Name | Lorita Beiler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073838066 PECOS PAC ID: 4789975392 Enrollment ID: I20160628002540 |
| Provider Name | Daniela Solzbacher |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992069504 PECOS PAC ID: 0941432702 Enrollment ID: I20160706000875 |
| Provider Name | Michael Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619003449 PECOS PAC ID: 1850683632 Enrollment ID: I20160714002391 |
| Provider Name | Paul Stevens |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1366736886 PECOS PAC ID: 9234356627 Enrollment ID: I20160809001081 |
| Provider Name | Maria Reyes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265728984 PECOS PAC ID: 1456597525 Enrollment ID: I20160825001463 |
| Provider Name | Marcela Smid |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588994727 PECOS PAC ID: 9537301080 Enrollment ID: I20160831000334 |
| Provider Name | Marc Porritt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659780369 PECOS PAC ID: 9032405915 Enrollment ID: I20160831002365 |
| Provider Name | Edward Mullaney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508294141 PECOS PAC ID: 9133415805 Enrollment ID: I20160906001755 |
| Provider Name | Summer N Rolin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730534587 PECOS PAC ID: 6709173461 Enrollment ID: I20160922002446 |
| Provider Name | Jon-kar Zubieta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902978844 PECOS PAC ID: 5991834517 Enrollment ID: I20160922002806 |
| Provider Name | Robert Frost |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437550415 PECOS PAC ID: 2668799982 Enrollment ID: I20161006000525 |
| Provider Name | Lee Hamilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437574373 PECOS PAC ID: 6103114111 Enrollment ID: I20161006001662 |
| Provider Name | Abigail Zeveloff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518211705 PECOS PAC ID: 7719275619 Enrollment ID: I20161010000453 |
| Provider Name | Rachel Mitchell Montague |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952857963 PECOS PAC ID: 3173801941 Enrollment ID: I20161028001601 |
| Provider Name | Anna Docherty |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760844161 PECOS PAC ID: 4880973064 Enrollment ID: I20161110001002 |
| Provider Name | Nichole Hill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558679621 PECOS PAC ID: 2567741770 Enrollment ID: I20161110001889 |
| Provider Name | Heather Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700293446 PECOS PAC ID: 2062791874 Enrollment ID: I20161118001595 |
| Provider Name | Sara Louise Weisenbach |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912179128 PECOS PAC ID: 8628147055 Enrollment ID: I20161128001228 |
| Provider Name | Lindsay Dawn Wilson-barlow |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275985624 PECOS PAC ID: 2163702549 Enrollment ID: I20161130000967 |
| Provider Name | Laura White |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760866008 PECOS PAC ID: 5294015129 Enrollment ID: I20161209001346 |
| Provider Name | Lindsay Embree |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386047587 PECOS PAC ID: 4082836333 Enrollment ID: I20170207002207 |
| Provider Name | Jonathan Birnkrant |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659385383 PECOS PAC ID: 2062435175 Enrollment ID: I20170329001580 |
| Provider Name | Brian Augustyn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306095633 PECOS PAC ID: 2264718535 Enrollment ID: I20170421000869 |
| Provider Name | Marta Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679864250 PECOS PAC ID: 0648547729 Enrollment ID: I20170519001682 |
| Provider Name | Kristen Leigh Pagel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427349042 PECOS PAC ID: 1456665082 Enrollment ID: I20170627000453 |
| Provider Name | Shawn Kohler |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467728907 PECOS PAC ID: 5092931220 Enrollment ID: I20170630001811 |
| Provider Name | Steven Sugden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366416489 PECOS PAC ID: 5092796987 Enrollment ID: I20170802000936 |
| Provider Name | Marilyn Schneider |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1083134910 PECOS PAC ID: 8426321803 Enrollment ID: I20170906003570 |
| Provider Name | Larissa Mcgarrity |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225567811 PECOS PAC ID: 8729352992 Enrollment ID: I20170927000873 |
| Provider Name | Linda Vezie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639694730 PECOS PAC ID: 8527333756 Enrollment ID: I20171013001259 |
| Provider Name | Katherine N Frichette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699134221 PECOS PAC ID: 3072889849 Enrollment ID: I20171023001250 |
| Provider Name | Patricia Aguayo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184931404 PECOS PAC ID: 1052546587 Enrollment ID: I20171025000788 |
| Provider Name | Sarah Shizuko Morimoto |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770919771 PECOS PAC ID: 7214156975 Enrollment ID: I20171205003078 |
| Provider Name | Stephanie Donnelly |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952760951 PECOS PAC ID: 1658669072 Enrollment ID: I20180109002650 |
| Provider Name | Sarah Hunt Mccormick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144734989 PECOS PAC ID: 0345509246 Enrollment ID: I20180123001930 |
| Provider Name | Jennifer N Griswold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275971483 PECOS PAC ID: 0941560791 Enrollment ID: I20180321002516 |
| Provider Name | Melissa Lynn Mott |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164833356 PECOS PAC ID: 0042528614 Enrollment ID: I20180412001818 |
| Provider Name | Corey Cutler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730189374 PECOS PAC ID: 3971754946 Enrollment ID: I20180412002681 |
| Provider Name | Jamie Lea Hales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083927800 PECOS PAC ID: 0244594307 Enrollment ID: I20180426001437 |
| Provider Name | Diana Neff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699120113 PECOS PAC ID: 3678838547 Enrollment ID: I20180523002326 |
| Provider Name | Keerthi P Vejerla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740621523 PECOS PAC ID: 4789998766 Enrollment ID: I20180531001651 |
| Provider Name | Rebecca P Kendrick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295225787 PECOS PAC ID: 3274898838 Enrollment ID: I20180531001696 |
| Provider Name | Jennifer Stanton Hatch |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841483146 PECOS PAC ID: 3779848197 Enrollment ID: I20180605002028 |
| Provider Name | Kristin R Becker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346370491 PECOS PAC ID: 1052667235 Enrollment ID: I20180629001987 |
| Provider Name | Rong Xiao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982946240 PECOS PAC ID: 6800017203 Enrollment ID: I20180702002700 |
| Provider Name | Jeremy Royle Stoddart |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023242815 PECOS PAC ID: 2163666157 Enrollment ID: I20180717003867 |
| Provider Name | Elizabeth A Gargaro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881013712 PECOS PAC ID: 0143538140 Enrollment ID: I20180719002905 |
| Provider Name | Ryan W Morgan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114242724 PECOS PAC ID: 0143493551 Enrollment ID: I20180806001348 |
| Provider Name | Elizabeth Greene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528414232 PECOS PAC ID: 1658620851 Enrollment ID: I20180821003940 |
| Provider Name | Kristina Marina Purganan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144454489 PECOS PAC ID: 3678710282 Enrollment ID: I20180831000709 |
| Provider Name | Cristie Frey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083099139 PECOS PAC ID: 5890045405 Enrollment ID: I20180831001300 |
| Provider Name | Michael J Moss |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629415567 PECOS PAC ID: 0244472991 Enrollment ID: I20181002000088 |
| Provider Name | Julia Ewanowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659850873 PECOS PAC ID: 5799038436 Enrollment ID: I20181026002133 |
| Provider Name | Yasaman Keshavarz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437638822 PECOS PAC ID: 5890049951 Enrollment ID: I20181108002794 |
| Provider Name | Andrew J Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356821847 PECOS PAC ID: 1557607835 Enrollment ID: I20190108000348 |
| Provider Name | Ann Gammell Cook |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275938441 PECOS PAC ID: 5799023420 Enrollment ID: I20190205001682 |
| Provider Name | Curtis Wilcox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780018754 PECOS PAC ID: 4587902911 Enrollment ID: I20190211001712 |
| Provider Name | Katherine Kitchen Andren |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508305467 PECOS PAC ID: 5193098259 Enrollment ID: I20190228001510 |
| Provider Name | Janene P. Fontaine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518202811 PECOS PAC ID: 7911247804 Enrollment ID: I20190312002044 |
| Provider Name | Dallas Bowles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588154124 PECOS PAC ID: 4688914369 Enrollment ID: I20190315000331 |
| Provider Name | Bryce Herrera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730591033 PECOS PAC ID: 3577803154 Enrollment ID: I20190318002027 |
| Provider Name | Andrea Farmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588141741 PECOS PAC ID: 5496095929 Enrollment ID: I20190320002096 |
| Provider Name | Rebecca Anne Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528228632 PECOS PAC ID: 7113154204 Enrollment ID: I20190321001973 |
| Provider Name | Kristina Joan Cottle Feldman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427488949 PECOS PAC ID: 2365782588 Enrollment ID: I20190325002139 |
| Provider Name | Megan Willes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639526098 PECOS PAC ID: 0244570257 Enrollment ID: I20190328001341 |
| Provider Name | Christian Porter Torres-george |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588145817 PECOS PAC ID: 4183965114 Enrollment ID: I20190401001107 |
| Provider Name | Corinne Ivy Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144787409 PECOS PAC ID: 5597006825 Enrollment ID: I20190413000049 |
| Provider Name | Scott A Langenecker |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316019839 PECOS PAC ID: 2264331875 Enrollment ID: I20190503001589 |
| Provider Name | Jessica D Farrar |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417227158 PECOS PAC ID: 8123361292 Enrollment ID: I20190514001236 |
| Provider Name | Jeffrey Dale Barratt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356768329 PECOS PAC ID: 9032428545 Enrollment ID: I20190529003185 |
| Provider Name | Jeffrey Grant Clark |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487041273 PECOS PAC ID: 0446561518 Enrollment ID: I20190611001011 |
| Provider Name | Tomas Melicher |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629450523 PECOS PAC ID: 6204169998 Enrollment ID: I20190612001374 |
| Provider Name | Michael Higgins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780038141 PECOS PAC ID: 9739413832 Enrollment ID: I20190624002025 |
| Provider Name | Joseph Un Kim |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518453406 PECOS PAC ID: 5890029599 Enrollment ID: I20190701000994 |
| Provider Name | Joseph Patrick Lamb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679130561 PECOS PAC ID: 8022343516 Enrollment ID: I20190703002156 |
| Provider Name | Tyson Charles Schwab |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023511961 PECOS PAC ID: 1254667595 Enrollment ID: I20190724004177 |
| Provider Name | Gabriel N Fette |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417376393 PECOS PAC ID: 5597091660 Enrollment ID: I20190726001542 |
| Provider Name | Amber Margolis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407416712 PECOS PAC ID: 1355677048 Enrollment ID: I20190802000977 |
| Provider Name | Amber Marie Porschatis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710400429 PECOS PAC ID: 5496083859 Enrollment ID: I20190822002146 |
| Provider Name | Michelle N Miranda |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295134070 PECOS PAC ID: 3870823586 Enrollment ID: I20190924000187 |
| Provider Name | Sarah Goldman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164084810 PECOS PAC ID: 0547590002 Enrollment ID: I20190925002927 |
| Provider Name | Emily Navar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619537941 PECOS PAC ID: 7911238472 Enrollment ID: I20191014003349 |
| Provider Name | Luke M Dwyer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750775664 PECOS PAC ID: 0840579694 Enrollment ID: I20191106000457 |
| Provider Name | Deborah Elizabeth Morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972156693 PECOS PAC ID: 3476985425 Enrollment ID: I20191113003245 |
| Provider Name | Melody Mickens |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942759626 PECOS PAC ID: 5496187189 Enrollment ID: I20191119000540 |
| Provider Name | Joshua Stephen Falk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821649443 PECOS PAC ID: 2062844772 Enrollment ID: I20191119001328 |
| Provider Name | Julie D Fitzwilliam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669851382 PECOS PAC ID: 3577996636 Enrollment ID: I20191203001415 |
| Provider Name | Danielle A Valdez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598164246 PECOS PAC ID: 2365875366 Enrollment ID: I20191205000995 |
| Provider Name | Molly Quick Mcfadden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184901522 PECOS PAC ID: 4688974330 Enrollment ID: I20191211002998 |
| Provider Name | Loran Patrick Hayes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922665249 PECOS PAC ID: 7810320330 Enrollment ID: I20191213000614 |
| Provider Name | Tricia Merkley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275944308 PECOS PAC ID: 9638390214 Enrollment ID: I20200117000422 |
| Provider Name | David F Tate |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568427664 PECOS PAC ID: 4385667328 Enrollment ID: I20200204000093 |
| Provider Name | Christina Jeanne Jeffery Cackler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528515798 PECOS PAC ID: 2466888664 Enrollment ID: I20200206002491 |
| Provider Name | Jordan W Merrill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902197007 PECOS PAC ID: 2668772195 Enrollment ID: I20200421003235 |
| Provider Name | David M Swan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861049363 PECOS PAC ID: 4183045040 Enrollment ID: I20200601001166 |
| Provider Name | Kathleen Marie Bonebrake |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245692466 PECOS PAC ID: 2062778574 Enrollment ID: I20200610000370 |
| Provider Name | Thomas Lyle Gethin-jones |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407200322 PECOS PAC ID: 4688930217 Enrollment ID: I20200619001152 |
| Provider Name | Lauren Tarbet |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942741871 PECOS PAC ID: 6800219700 Enrollment ID: I20200710002151 |
| Provider Name | Kayla Krstyen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356693733 PECOS PAC ID: 3476976226 Enrollment ID: I20200713000567 |
| Provider Name | Kelly L Godecke |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851788897 PECOS PAC ID: 7012297518 Enrollment ID: I20200807002739 |
| Provider Name | Shannon Lee Zaryoun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710595178 PECOS PAC ID: 3173942950 Enrollment ID: I20200928002345 |
| Provider Name | Joshua A Morris |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093327140 PECOS PAC ID: 1254750441 Enrollment ID: I20201008000598 |
| Provider Name | Sarah Theo Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770192106 PECOS PAC ID: 3072933159 Enrollment ID: I20201009002238 |
| Provider Name | Melissa Mauchley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811501414 PECOS PAC ID: 9436579984 Enrollment ID: I20201021002972 |
| Provider Name | Amos Richard Grim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013408806 PECOS PAC ID: 3072843473 Enrollment ID: I20201223000942 |
| Provider Name | Amy Irvin |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1578987574 PECOS PAC ID: 0446663561 Enrollment ID: I20210111001866 |
| Provider Name | Suzanne Latrice Henry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073118998 PECOS PAC ID: 4486067402 Enrollment ID: I20210113000792 |
| Provider Name | Valois Anne Feneziani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568070902 PECOS PAC ID: 4385059716 Enrollment ID: I20210217002741 |
| Provider Name | Michelle Accardi-ravid |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689094294 PECOS PAC ID: 9234417643 Enrollment ID: I20210318001495 |
| Provider Name | Andrew Lee Hemingway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326626169 PECOS PAC ID: 0244648921 Enrollment ID: I20210419000481 |
| Provider Name | Seth A Migdalski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659734283 PECOS PAC ID: 7214224732 Enrollment ID: I20210420002339 |
| Provider Name | Mixael G Zirio Mustafa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578963807 PECOS PAC ID: 6204120827 Enrollment ID: I20210423001973 |
| Provider Name | Carlie M Benson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932631611 PECOS PAC ID: 9436402963 Enrollment ID: I20210427002661 |
| Provider Name | Kenneth Todd Pehrson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215221957 PECOS PAC ID: 8527282987 Enrollment ID: I20210527001288 |
| Provider Name | Amanda Edith Fujiki |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750745857 PECOS PAC ID: 3971869512 Enrollment ID: I20210528001438 |
| Provider Name | Karen Christine Manotas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689028813 PECOS PAC ID: 7113283771 Enrollment ID: I20210603002704 |
| Provider Name | Megan Chochol |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952764045 PECOS PAC ID: 7113253162 Enrollment ID: I20210607003280 |
| Provider Name | Myles Antonioli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609320050 PECOS PAC ID: 4688949928 Enrollment ID: I20210608002120 |
| Provider Name | Amber Nicole Mackey Wilson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538506472 PECOS PAC ID: 9032337621 Enrollment ID: I20210702000335 |
| Provider Name | Taylor Berhow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477921872 PECOS PAC ID: 9739581596 Enrollment ID: I20210715003049 |
| Provider Name | Britan Mary Heavrin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194395442 PECOS PAC ID: 9739582941 Enrollment ID: I20210726003225 |
| Provider Name | Carol Anne Eddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265683593 PECOS PAC ID: 7315340197 Enrollment ID: I20210730002886 |
| Provider Name | Ryan O Cephas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396277125 PECOS PAC ID: 5991129553 Enrollment ID: I20210804003940 |
| Provider Name | Mary Bank |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215482617 PECOS PAC ID: 8628473519 Enrollment ID: I20210816000839 |
| Provider Name | Melinda Westlund Schreiner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710556543 PECOS PAC ID: 3678978525 Enrollment ID: I20210816003388 |
| Provider Name | Cynthia E Palacios-gutierrez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407160070 PECOS PAC ID: 5092110866 Enrollment ID: I20210818000755 |
| Provider Name | Spencer W Liebel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295309987 PECOS PAC ID: 2567867690 Enrollment ID: I20210826003361 |
| Provider Name | Alyssa Hickert |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164874095 PECOS PAC ID: 3274895966 Enrollment ID: I20210909002428 |
| Provider Name | Amira Dervisevic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881360295 PECOS PAC ID: 8628475688 Enrollment ID: I20210920000451 |
| Provider Name | Jade Rijsketic |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578104378 PECOS PAC ID: 6204233729 Enrollment ID: I20210927002316 |
| Provider Name | Mark H Rapaport |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194709998 PECOS PAC ID: 8325946478 Enrollment ID: I20210929002787 |
| Provider Name | Madison Niermeyer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982944179 PECOS PAC ID: 6507264140 Enrollment ID: I20211012001030 |
| Provider Name | Rosalva Guzman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689346140 PECOS PAC ID: 9234537580 Enrollment ID: I20211018001559 |
| Provider Name | Elizabeth Foxley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336781913 PECOS PAC ID: 8729476833 Enrollment ID: I20211021003287 |
| Provider Name | Christine Marie Mullen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083225395 PECOS PAC ID: 1759770365 Enrollment ID: I20211118003174 |
| Provider Name | Kristen A Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023631868 PECOS PAC ID: 0143639211 Enrollment ID: I20220120000358 |
| Provider Name | Amanda Russell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699730952 PECOS PAC ID: 0244623528 Enrollment ID: I20220209001191 |
| Provider Name | Jaeyong Cho |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780148643 PECOS PAC ID: 1052705977 Enrollment ID: I20220218000716 |
| Provider Name | Sari Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114483138 PECOS PAC ID: 1557602380 Enrollment ID: I20220414001067 |
| Provider Name | Donna Beagley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417367871 PECOS PAC ID: 4183011307 Enrollment ID: I20220418001705 |
| Provider Name | Kirk B Bjella |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912394735 PECOS PAC ID: 7012298292 Enrollment ID: I20220418002391 |
| Provider Name | Shannon Roghaar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932577897 PECOS PAC ID: 6204213754 Enrollment ID: I20220523000531 |
| Provider Name | Jeffrey A Pedersen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316478290 PECOS PAC ID: 4880962869 Enrollment ID: I20220609001086 |
| Provider Name | Tyler A Durns |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497288351 PECOS PAC ID: 0244583722 Enrollment ID: I20220609002275 |
| Provider Name | Graydon Dan Larsen |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1730857285 PECOS PAC ID: 6305226549 Enrollment ID: I20220706003070 |
| Provider Name | John Sensiba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154075885 PECOS PAC ID: 1254714140 Enrollment ID: I20220809003902 |
| Provider Name | Matthew Brent Checketts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023373305 PECOS PAC ID: 5799168662 Enrollment ID: I20220810003056 |
| Provider Name | Rebecca Maria Jones |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1386398188 PECOS PAC ID: 4486037884 Enrollment ID: I20220817003771 |
| Provider Name | Elizabeth Penner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891138798 PECOS PAC ID: 9032539184 Enrollment ID: I20220822002869 |
| Provider Name | Hannah Wright |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1275268401 PECOS PAC ID: 0446634489 Enrollment ID: I20220825000983 |
| Provider Name | Callee Laplant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275989899 PECOS PAC ID: 2365827383 Enrollment ID: I20220912002485 |
| Provider Name | Paula Cristina Pena |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538837463 PECOS PAC ID: 9032594064 Enrollment ID: I20220912002801 |
| Provider Name | Christopher Wesley Pace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043829328 PECOS PAC ID: 7113302795 Enrollment ID: I20220917000632 |
| Provider Name | Sarah Anne Mitchell |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1235886250 PECOS PAC ID: 8921484015 Enrollment ID: I20220927001637 |
| Provider Name | Jordan B Koncinsky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659803294 PECOS PAC ID: 2961756689 Enrollment ID: I20221012001923 |
| Provider Name | Hannah Farnsworth |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134654510 PECOS PAC ID: 9335515618 Enrollment ID: I20221012002150 |
| Provider Name | Cara Marie Diclemente |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548889629 PECOS PAC ID: 7618343898 Enrollment ID: I20221012002545 |
| Provider Name | Heather Margaret Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235851726 PECOS PAC ID: 1052788189 Enrollment ID: I20221102002939 |
| Provider Name | Lucy Izard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932561446 PECOS PAC ID: 6305261603 Enrollment ID: I20221111000337 |
| Provider Name | Erin Kaufman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124496989 PECOS PAC ID: 3678941739 Enrollment ID: I20221121001589 |
| Provider Name | Jackie Marie Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215552765 PECOS PAC ID: 3577931351 Enrollment ID: I20221129001578 |
| Provider Name | Natalie Ann Catlett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780305029 PECOS PAC ID: 7517335268 Enrollment ID: I20221130001610 |
| Provider Name | Gina Margoth Wehling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174033237 PECOS PAC ID: 1052789682 Enrollment ID: I20221201001840 |
| Provider Name | Elizabeth Ann Fuss |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649880410 PECOS PAC ID: 5395114938 Enrollment ID: I20221203000216 |
| Provider Name | Karla Vera Molinero |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609238252 PECOS PAC ID: 5597015560 Enrollment ID: I20221212001589 |
| Provider Name | Channing Jovi Cochran |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053947804 PECOS PAC ID: 2264802727 Enrollment ID: I20221228002242 |
| Provider Name | Nathan Scott Rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720799638 PECOS PAC ID: 2062883705 Enrollment ID: I20230117002521 |
| Provider Name | Hannah Mary Van Alstine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497284772 PECOS PAC ID: 9537531405 Enrollment ID: I20230202003174 |
| Provider Name | Christopher Warren Jankowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972005023 PECOS PAC ID: 5991177685 Enrollment ID: I20230206002074 |
| Provider Name | Aryssa Zyniche Washington |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487268165 PECOS PAC ID: 6305218637 Enrollment ID: I20230214001067 |
| Provider Name | Molly Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598386229 PECOS PAC ID: 0840662185 Enrollment ID: I20230214001603 |
| Provider Name | Heather Lynn Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750088803 PECOS PAC ID: 6002289568 Enrollment ID: I20230302002309 |
| Provider Name | Sara Elizabeth Carter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245943430 PECOS PAC ID: 8921471434 Enrollment ID: I20230303001372 |
| Provider Name | Sally B Bringhurst |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235437435 PECOS PAC ID: 9032584099 Enrollment ID: I20230405002568 |
| Provider Name | Paola Melissa Diaz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518655075 PECOS PAC ID: 7517323827 Enrollment ID: I20230511001396 |
| Provider Name | Ileana Marie Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528768652 PECOS PAC ID: 2264898964 Enrollment ID: I20230523001812 |
| Provider Name | Tobin J Ehrlich |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841923166 PECOS PAC ID: 2668839564 Enrollment ID: I20230608001246 |
| Provider Name | Kysha Hill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598469827 PECOS PAC ID: 6800254103 Enrollment ID: I20230619001405 |
| Provider Name | Matthew Euler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801509054 PECOS PAC ID: 4688032402 Enrollment ID: I20230626002670 |
| Provider Name | Rana Jawish |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578050837 PECOS PAC ID: 1456605898 Enrollment ID: I20230707000855 |
| Provider Name | Katherine Colleen Trimm |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417648510 PECOS PAC ID: 8729440383 Enrollment ID: I20230814001710 |
| Provider Name | Kevin J. Byrne |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700348463 PECOS PAC ID: 8527486083 Enrollment ID: I20230816003676 |
| Provider Name | Jazmin Nicole Mogavero |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386260453 PECOS PAC ID: 2961864285 Enrollment ID: I20230817001625 |
| Provider Name | Jeannett Eileen Madsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922784933 PECOS PAC ID: 0345694386 Enrollment ID: I20230926001237 |
| Provider Name | Rebecca Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245955921 PECOS PAC ID: 8123475605 Enrollment ID: I20231104000541 |
| Provider Name | Brittany Mae Lang |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124703269 PECOS PAC ID: 6709233018 Enrollment ID: I20231108001620 |
| Provider Name | Heidi B. Gross |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083177174 PECOS PAC ID: 2668890542 Enrollment ID: I20231108001786 |
| Provider Name | Emily J White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033991427 PECOS PAC ID: 8921458894 Enrollment ID: I20231219002760 |
| Provider Name | Reilly Beth Rockwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245917921 PECOS PAC ID: 4385094119 Enrollment ID: I20231220001128 |
| Provider Name | Chandra Tewari |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275008757 PECOS PAC ID: 1658714951 Enrollment ID: I20240202002970 |
| Provider Name | Brooke Castleberry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437629607 PECOS PAC ID: 3072957679 Enrollment ID: I20240222002266 |
| Provider Name | Traci Rosvall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518465913 PECOS PAC ID: 2264782283 Enrollment ID: I20240227003871 |
| Provider Name | Annette Curtis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558586941 PECOS PAC ID: 1759728272 Enrollment ID: I20240320000895 |
| Provider Name | Heather Lewis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699545640 PECOS PAC ID: 6800234659 Enrollment ID: I20240329001755 |
| Provider Name | Jennifer Pringle |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1386777951 PECOS PAC ID: 9931330404 Enrollment ID: I20240401001830 |
| Provider Name | Brian Baucom |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982868378 PECOS PAC ID: 4688012735 Enrollment ID: I20240409001393 |
| Provider Name | Ciara Pearle Larson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194251298 PECOS PAC ID: 9931548898 Enrollment ID: I20240411004570 |
| Provider Name | Krysta Marie Parker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235822420 PECOS PAC ID: 8022457837 Enrollment ID: I20240412002219 |
| Provider Name | Amanda Kutz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245756394 PECOS PAC ID: 3274973615 Enrollment ID: I20240501003587 |
| Provider Name | Carly Schuller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871106856 PECOS PAC ID: 6901246347 Enrollment ID: I20240501003610 |
| Provider Name | Alissa K Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780313213 PECOS PAC ID: 2062853716 Enrollment ID: I20240511000436 |
| Provider Name | Jessie Liwanu Welch-stockton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235980053 PECOS PAC ID: 1850733809 Enrollment ID: I20240522003719 |
| Provider Name | Kelsey Rae Traeger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548928120 PECOS PAC ID: 1153763834 Enrollment ID: I20240527000403 |
| Provider Name | Amy Adair Bingham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104318179 PECOS PAC ID: 4284176629 Enrollment ID: I20240612003973 |
Shrinkster, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 860 E 4500 S Ste 302, Salt Lake City, UT 84107 Phone: 801-685-9600 Fax: 801-268-3777 | |
Burton Counseling Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1433 S 1100 E, Salt Lake City, UT 84105 Phone: 801-581-0422 | |
Sacred Circle Health Care Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 660 S 200 E Ste 250, Salt Lake City, UT 84111 Phone: 801-359-2256 Fax: 801-364-4392 | |
Palliative Medicine Associates Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 888 E 3900 S, Suite B, Salt Lake City, UT 84107 Phone: 801-747-0330 | |
Journey Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1343 S Main St Ste B, Salt Lake City, UT 84115 Phone: 801-803-8105 | |
Blossom Aba Therapy Ut Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2795 E Cottonwood Pkwy, Salt Lake City, UT 84121 Phone: 732-730-7505 | |
Michael S Buxton Phd Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1399 S 700 E Ste 11, Salt Lake City, UT 84105 Phone: 801-318-1900 |