| San Juan Counseling | |
|
356 S Main St Blanding UT 84511-3830 | |
| (435) 678-2992 | |
| (435) 678-3116 |
| Full Name | San Juan Counseling |
|---|---|
| Speciality | Clinic/Center |
| Location | 356 S Main St, Blanding, Utah |
| Authorized Official Name and Position | Jed E. Lyman (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4356782992 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Juan Counseling 356 S Main St Blanding UT 84511-3830 Ph: (435) 678-2992 | San Juan Counseling 356 S Main St Blanding UT 84511-3830 Ph: (435) 678-2992 |
| NPI Number | 1356353692 |
|---|---|
| Provider Enumeration Date | 08/13/2006 |
| Last Update Date | 06/19/2014 |
| Medicare PECOS PAC ID | 9638124910 |
|---|---|
| Medicare Enrollment ID | O20050319000027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356353692 | NPI | - | NPPES |
| 876000305005 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 11054 (Utah) | Primary |
| Provider Name | Stephen H Hiatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750413803 PECOS PAC ID: 3577645910 Enrollment ID: I20080124000397 |
| Provider Name | Ryan L Heck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376667048 PECOS PAC ID: 3173749470 Enrollment ID: I20140722002699 |
| Provider Name | Mark J Keller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881986966 PECOS PAC ID: 5092035550 Enrollment ID: I20180328000277 |
| Provider Name | Katie M Eberling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881142669 PECOS PAC ID: 0547691883 Enrollment ID: I20200520002518 |
| Provider Name | Melinda Chamberlain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053750570 PECOS PAC ID: 6901216969 Enrollment ID: I20201102002111 |
| Provider Name | Aaron M Duke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144995788 PECOS PAC ID: 5991101420 Enrollment ID: I20210909001411 |
| Provider Name | Gavin P Chatterley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437546058 PECOS PAC ID: 3375940943 Enrollment ID: I20210923002983 |
| Provider Name | Julie A Mahlstede |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801532288 PECOS PAC ID: 3577944529 Enrollment ID: I20220721002626 |
| Provider Name | Grady C Shumway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407242399 PECOS PAC ID: 5991155368 Enrollment ID: I20231227001796 |