|
| |
|
310 E 4500 S Ste 600 Murray UT 84107-4246 | |
| (801) 264-9522 | |
| (801) 265-9604 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 310 E 4500 S Ste 600, Murray, Utah |
| Authorized Official Name and Position | Kerry Biscornet (SECRETARY) |
| Authorized Official Contact | 6088542929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11000 Optum Cir Eden Prairie MN 55344-2503 Ph: (608) 854-2929 | 310 E 4500 S Ste 600 Murray UT 84107-4246 Ph: (801) 264-9522 |
| NPI Number | 1942076633 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 04/24/2024 |
| Certification Date | 04/24/2024 |
| Medicare PECOS PAC ID | 7719325083 |
|---|---|
| Medicare Enrollment ID | O20240723004739 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942076633 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Tamara Lynn Broadhead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124548789 PECOS PAC ID: 4183981665 Enrollment ID: I20171208002076 |
| Provider Name | Teresa Galloway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285933614 PECOS PAC ID: 7012349228 Enrollment ID: I20191108001346 |
| Provider Name | Tara Rainey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235752536 PECOS PAC ID: 6002268059 Enrollment ID: I20240116001941 |
| Provider Name | Bobette Page |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316052319 PECOS PAC ID: 2466628912 Enrollment ID: I20240116003765 |
| Provider Name | Mark Barnhurst |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366885519 PECOS PAC ID: 6204288640 Enrollment ID: I20240122001196 |
| Provider Name | Benjamin Ashby Sparks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790460269 PECOS PAC ID: 4183077662 Enrollment ID: I20240131003957 |
| Provider Name | Loren D Mitchell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932342516 PECOS PAC ID: 7719102144 Enrollment ID: I20240208003409 |
| Provider Name | Michelle J Nixon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760695837 PECOS PAC ID: 2466896097 Enrollment ID: I20240221004415 |
Sego Lily Center For The Abused Deaf Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6526 S State St, 404, Murray, UT 84107 Phone: 888-328-5486 Fax: 888-328-5486 | |
Blue Autism Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1233 W Brister Dr, Murray, UT 84123 Phone: 925-338-4764 | |
Meridian Counseling: Individual And Family Therapy, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4516 S 700 E Ste 170, Murray, UT 84107 Phone: 323-332-9905 | |
Whitehawk Consulting, P.c. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 5801 Fashion Blvd, Suite 250, Murray, UT 84107 Phone: 801-913-5543 | |
Live For Life Aspen, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 179 W Winchester St, Murray, UT 84107 Phone: 801-666-6834 |