| Neurobehavioral Center For Growth Llc | |
|
415 Medical Dr Ste A100 Bountiful UT 84010-4995 | |
| (801) 683-1062 | |
| (801) 294-2643 |
| Full Name | Neurobehavioral Center For Growth Llc |
|---|---|
| Speciality | Psychologist |
| Location | 415 Medical Dr Ste A100, Bountiful, Utah |
| Authorized Official Name and Position | Jennifer Rigby Cardinal (PSYCHOLOGIST) |
| Authorized Official Contact | 8016831062 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurobehavioral Center For Growth Llc 415 Medical Dr Ste A100 Bountiful UT 84010-4995 Ph: (801) 683-1062 | Neurobehavioral Center For Growth Llc 415 Medical Dr Ste A100 Bountiful UT 84010-4995 Ph: (801) 683-1062 |
| NPI Number | 1942641931 |
|---|---|
| Provider Enumeration Date | 07/08/2013 |
| Last Update Date | 12/20/2021 |
| Certification Date | 12/20/2021 |
| Medicare PECOS PAC ID | 4183859622 |
|---|---|
| Medicare Enrollment ID | O20131108000961 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942641931 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Carmela J Javellana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215031778 PECOS PAC ID: 9436130887 Enrollment ID: I20040601000404 |
| Provider Name | Jennifer Cardinal |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467898197 PECOS PAC ID: 3173758612 Enrollment ID: I20131108001007 |
| Provider Name | La Ree Coleen O'reilly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699009548 PECOS PAC ID: 3779917448 Enrollment ID: I20200106001454 |
| Provider Name | Nicole I Medina |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235488008 PECOS PAC ID: 6800212861 Enrollment ID: I20200820002747 |
| Provider Name | Amos Richard Grim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013408806 PECOS PAC ID: 3072843473 Enrollment ID: I20201223000942 |
| Provider Name | Lyndsey Marie Evans |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053870626 PECOS PAC ID: 2163836727 Enrollment ID: I20210122002059 |
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