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251 S Mountain Rd Ste 1 Fruit Heights UT 84037-2371 | |
(385) 381-4950 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 251 S Mountain Rd Ste 1, Fruit Heights, Utah |
Authorized Official Name and Position | Tyler Farnes (OWNER) |
Authorized Official Contact | 8012315942 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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251 S Mountain Rd Ste 1 Fruit Heights UT 84037-2371 Ph: (801) 643-2030 | 251 S Mountain Rd Ste 1 Fruit Heights UT 84037-2371 Ph: (385) 381-4950 |
NPI Number | 1932833456 |
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Provider Enumeration Date | 07/11/2022 |
Last Update Date | 05/20/2024 |
Certification Date | 05/20/2024 |
Medicare PECOS PAC ID | 2264974088 |
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Medicare Enrollment ID | O20240608000053 |
Identifier | Type | State | Issuer |
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1932833456 | NPI | - | NPPES |
Provider Name | Melissa Weathers |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1235429168 PECOS PAC ID: 0648712224 Enrollment ID: I20240611001988 |
Provider Name | Jeffrey Jay Gregson |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1952450678 PECOS PAC ID: 3173065992 Enrollment ID: I20240611002339 |