| Wasatch Behavioral Health Special Service District | |
|
750 N Freedom Blvd Suite 300 Provo UT 84601 | |
| (801) 373-4760 | |
| (801) 373-0639 |
| Full Name | Wasatch Behavioral Health Special Service District |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 750 N Freedom Blvd, Provo, Utah |
| Authorized Official Name and Position | Doran Williams (ASSOCIATE DIRECTORE) |
| Authorized Official Contact | 8013734760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wasatch Behavioral Health Special Service District 750 N Freedom Blvd Suite 300 Provo UT 84601 Ph: (801) 373-4760 | Wasatch Behavioral Health Special Service District 750 N Freedom Blvd Suite 300 Provo UT 84601 Ph: (801) 373-4760 |
| NPI Number | 1356357115 |
|---|---|
| Provider Enumeration Date | 08/01/2006 |
| Last Update Date | 04/30/2021 |
| Certification Date | 04/30/2021 |
| Medicare PECOS PAC ID | 2567367915 |
|---|---|
| Medicare Enrollment ID | O20031129000014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356357115 | NPI | - | NPPES |
| 870285565012 | Medicaid | UT |
| Provider Name | Brian W Butler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326146663 PECOS PAC ID: 9931000361 Enrollment ID: I20040117000233 |
| Provider Name | Dean Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982716197 PECOS PAC ID: 8921994195 Enrollment ID: I20040225000067 |
| Provider Name | David T Blume |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255448130 PECOS PAC ID: 7719873835 Enrollment ID: I20040225000960 |
| Provider Name | Randy M Huntington |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356432058 PECOS PAC ID: 8123914116 Enrollment ID: I20040226000070 |
| Provider Name | Mary J Ridges |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053968529 PECOS PAC ID: 5193611192 Enrollment ID: I20040226000154 |
| Provider Name | Lawrence Paul Dunning |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1154432060 PECOS PAC ID: 5799672028 Enrollment ID: I20040302000572 |
| Provider Name | Kathleen D Howard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306944640 PECOS PAC ID: 3274420088 Enrollment ID: I20040304000255 |
| Provider Name | Gerald M Lazar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003883349 PECOS PAC ID: 7416913199 Enrollment ID: I20041203000934 |
| Provider Name | Elizabeth Feil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912018730 PECOS PAC ID: 2860449782 Enrollment ID: I20050404000284 |
| Provider Name | Goldia Hollingsworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770674541 PECOS PAC ID: 9133176878 Enrollment ID: I20050405000343 |
| Provider Name | William C Dunaway |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316121502 PECOS PAC ID: 9638110281 Enrollment ID: I20050513000568 |
| Provider Name | Bret J Linton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083715346 PECOS PAC ID: 1658308127 Enrollment ID: I20050726001070 |
| Provider Name | Dallas L Earnshaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780777649 PECOS PAC ID: 9032148994 Enrollment ID: I20050810001103 |
| Provider Name | Robert Scott Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124130331 PECOS PAC ID: 0749215986 Enrollment ID: I20050927000991 |
| Provider Name | Randal Scott Pennington |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801903786 PECOS PAC ID: 0345275582 Enrollment ID: I20050927001020 |
| Provider Name | Blaine A Winters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982794574 PECOS PAC ID: 3779508130 Enrollment ID: I20051013001107 |
| Provider Name | Ed Zunkowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952413163 PECOS PAC ID: 6204855828 Enrollment ID: I20051114000294 |
| Provider Name | Leslie W Miles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912005240 PECOS PAC ID: 0840204830 Enrollment ID: I20060130000240 |
| Provider Name | Tim W Mcgaughy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588757389 PECOS PAC ID: 8729096367 Enrollment ID: I20070814000394 |
| Provider Name | Laura B Oaks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356436018 PECOS PAC ID: 9032203385 Enrollment ID: I20070918000563 |
| Provider Name | Joseph C Limb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235241449 PECOS PAC ID: 1153419890 Enrollment ID: I20071114000266 |
| Provider Name | Michael King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255363982 PECOS PAC ID: 6608951223 Enrollment ID: I20080306000608 |
| Provider Name | Theresa E Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780890939 PECOS PAC ID: 2264507961 Enrollment ID: I20080814000433 |
| Provider Name | Lilliam M Henningson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225158967 PECOS PAC ID: 9436217064 Enrollment ID: I20081024000644 |
| Provider Name | Tyler Jenson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972696748 PECOS PAC ID: 5698834976 Enrollment ID: I20081030000777 |
| Provider Name | Lisa Jane Olsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134105364 PECOS PAC ID: 6305907734 Enrollment ID: I20081204000116 |
| Provider Name | Darren J Gillespie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205943180 PECOS PAC ID: 7012071731 Enrollment ID: I20090126000071 |
| Provider Name | Adrienne Duffany |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134220635 PECOS PAC ID: 2163586587 Enrollment ID: I20090130000184 |
| Provider Name | Michael A Wilkins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386959583 PECOS PAC ID: 0941493472 Enrollment ID: I20101018000073 |
| Provider Name | Thomas O Yee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659456754 PECOS PAC ID: 1052591807 Enrollment ID: I20110210000720 |
| Provider Name | Kayelyn Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033430848 PECOS PAC ID: 0941479042 Enrollment ID: I20110805000722 |
| Provider Name | Christopher David Westover |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891000790 PECOS PAC ID: 0749432755 Enrollment ID: I20121219000551 |
| Provider Name | Jaime Lee Houskeeper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407159007 PECOS PAC ID: 6608020540 Enrollment ID: I20130131000333 |
| Provider Name | Clint W Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063642510 PECOS PAC ID: 9537384920 Enrollment ID: I20140626001651 |
| Provider Name | David M Ockey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376835793 PECOS PAC ID: 9638398944 Enrollment ID: I20140918002706 |
| Provider Name | Karen Amsden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023109717 PECOS PAC ID: 0446573745 Enrollment ID: I20141217001364 |
| Provider Name | Joshua Jenkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548503865 PECOS PAC ID: 8426371725 Enrollment ID: I20141217001434 |
| Provider Name | Florentino Hopoate |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629242052 PECOS PAC ID: 5395069868 Enrollment ID: I20150112001162 |
| Provider Name | Nichole Thompson Hunter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295016178 PECOS PAC ID: 1557685773 Enrollment ID: I20150116002190 |
| Provider Name | Travis Hunter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114153137 PECOS PAC ID: 4082938220 Enrollment ID: I20150119000575 |
| Provider Name | Sheri Rowley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326218322 PECOS PAC ID: 1557685476 Enrollment ID: I20150126001288 |
| Provider Name | Heidi Busch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336564178 PECOS PAC ID: 5294013322 Enrollment ID: I20161025001268 |
| Provider Name | Janet Welling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720470677 PECOS PAC ID: 0143508192 Enrollment ID: I20161026002777 |
| Provider Name | Lynette Beard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851698914 PECOS PAC ID: 5991083438 Enrollment ID: I20161103000795 |
| Provider Name | Kevin Harmon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154731438 PECOS PAC ID: 8820378698 Enrollment ID: I20161213002320 |
| Provider Name | Marcia K Lidtke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972716496 PECOS PAC ID: 7214010271 Enrollment ID: I20170301002328 |
| Provider Name | Dallas Bean |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013215599 PECOS PAC ID: 9739463993 Enrollment ID: I20170307001517 |
| Provider Name | Alexander Gray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649538000 PECOS PAC ID: 6406131358 Enrollment ID: I20170316001027 |
| Provider Name | Joseph Fair |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376919381 PECOS PAC ID: 5496031395 Enrollment ID: I20170407000274 |
| Provider Name | Gary Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063962140 PECOS PAC ID: 7214209501 Enrollment ID: I20170822000592 |
| Provider Name | Susan Marie Stroud |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932591112 PECOS PAC ID: 1951674761 Enrollment ID: I20170830000748 |
| Provider Name | Mark E Hubner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861439499 PECOS PAC ID: 0042586281 Enrollment ID: I20171016003330 |
| Provider Name | Amanda Hanson Stansfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104918424 PECOS PAC ID: 8224388749 Enrollment ID: I20180904003197 |
| Provider Name | Younchan Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609223726 PECOS PAC ID: 0446501407 Enrollment ID: I20181002000176 |
| Provider Name | Wendy Hendley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538510896 PECOS PAC ID: 4981956760 Enrollment ID: I20181004002884 |
| Provider Name | Adrianne Moody |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548670086 PECOS PAC ID: 9335492172 Enrollment ID: I20181025000548 |
| Provider Name | Caroline Elizabeth Conley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417459892 PECOS PAC ID: 6406109156 Enrollment ID: I20181025001548 |
| Provider Name | Stephanie A Mcdonald |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689193906 PECOS PAC ID: 2264776095 Enrollment ID: I20181205003648 |
| Provider Name | Kristen Mari Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699121913 PECOS PAC ID: 7315282985 Enrollment ID: I20181231001028 |
| Provider Name | Justin Mark Coombs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376910737 PECOS PAC ID: 5092051557 Enrollment ID: I20190104001257 |
| Provider Name | Connie Lynn Winn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083016216 PECOS PAC ID: 8527305937 Enrollment ID: I20190123002599 |
| Provider Name | Mitchell Wayne Harris |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053619585 PECOS PAC ID: 0941549364 Enrollment ID: I20190301002031 |
| Provider Name | Rosa Idalia Reyes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821461690 PECOS PAC ID: 8628318607 Enrollment ID: I20190329001398 |
| Provider Name | Adriana Rosenblatt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467818229 PECOS PAC ID: 5193067981 Enrollment ID: I20190426000564 |
| Provider Name | Amy Buehler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679551634 PECOS PAC ID: 9830424373 Enrollment ID: I20190705000584 |
| Provider Name | Alisa Erickson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851604276 PECOS PAC ID: 3274860903 Enrollment ID: I20190802002912 |
| Provider Name | Jean Ockey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639590656 PECOS PAC ID: 9436486818 Enrollment ID: I20190807003023 |
| Provider Name | Jennifer Atwood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386856920 PECOS PAC ID: 1456688464 Enrollment ID: I20190814002378 |
| Provider Name | Tia White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205142148 PECOS PAC ID: 7416285481 Enrollment ID: I20190829000605 |
| Provider Name | Derra Gullickson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255851333 PECOS PAC ID: 8224461926 Enrollment ID: I20191211001458 |
| Provider Name | Sara M Terry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437324969 PECOS PAC ID: 1153755368 Enrollment ID: I20191221000375 |
| Provider Name | Kevan Anthony Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407223951 PECOS PAC ID: 2365878105 Enrollment ID: I20200214000397 |
| Provider Name | Eric Dennis Patterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760867287 PECOS PAC ID: 8325477979 Enrollment ID: I20200401002998 |
| Provider Name | Iesha Vicktoria Bailey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457871592 PECOS PAC ID: 2961823307 Enrollment ID: I20200610002714 |
| Provider Name | Lisa O'donnal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124584867 PECOS PAC ID: 6507280724 Enrollment ID: I20200721003407 |
| Provider Name | Jason Mark Webb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881865848 PECOS PAC ID: 7810315843 Enrollment ID: I20200908002314 |
| Provider Name | Melinda Chamberlain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053750570 PECOS PAC ID: 6901216969 Enrollment ID: I20201102002111 |
| Provider Name | Jared Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073917407 PECOS PAC ID: 0345655437 Enrollment ID: I20210223002935 |
| Provider Name | Mindy Sutton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467821546 PECOS PAC ID: 2860807815 Enrollment ID: I20210225000010 |
| Provider Name | Erin Beth Awerkamp |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033692439 PECOS PAC ID: 1254747884 Enrollment ID: I20210307000001 |
| Provider Name | Corry Douglas Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972010882 PECOS PAC ID: 4981004058 Enrollment ID: I20210610001710 |
| Provider Name | Kristi Joanne Hard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780179739 PECOS PAC ID: 5294130068 Enrollment ID: I20210818000684 |
| Provider Name | Adarienn Elizabeth Marrott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992155709 PECOS PAC ID: 3375938293 Enrollment ID: I20220311000448 |
| Provider Name | Zachary Scott Larkin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205316973 PECOS PAC ID: 7416344270 Enrollment ID: I20220425002439 |
| Provider Name | Scott Mcleod Curry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538583935 PECOS PAC ID: 0749667939 Enrollment ID: I20220509001528 |
| Provider Name | Laura Louise Vanderhoff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316593239 PECOS PAC ID: 4587043377 Enrollment ID: I20220624001837 |
| Provider Name | Holly Kaye Ancell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194209825 PECOS PAC ID: 6103206537 Enrollment ID: I20220701001731 |
| Provider Name | Sarah Krupa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487128104 PECOS PAC ID: 9335522150 Enrollment ID: I20220811001830 |
| Provider Name | Melissa Sue Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386293926 PECOS PAC ID: 3678999430 Enrollment ID: I20221004000693 |
| Provider Name | Page Marc Bowler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619353885 PECOS PAC ID: 1759758246 Enrollment ID: I20221114001995 |
| Provider Name | Logan Telford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730802810 PECOS PAC ID: 2062880214 Enrollment ID: I20221121000621 |
| Provider Name | Angela Rae Hernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306308036 PECOS PAC ID: 1456689140 Enrollment ID: I20221223001032 |
| Provider Name | Christopher Sterling Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528434677 PECOS PAC ID: 1759753163 Enrollment ID: I20230213001835 |
| Provider Name | Michael Scott Hancock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942788765 PECOS PAC ID: 1456724632 Enrollment ID: I20230309000966 |
| Provider Name | David John Sindt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740837046 PECOS PAC ID: 9133593569 Enrollment ID: I20230324002149 |
| Provider Name | Chantry Daniel Carter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245707975 PECOS PAC ID: 6305211103 Enrollment ID: I20230410000906 |
| Provider Name | Cassie L Helferich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184331332 PECOS PAC ID: 8527433275 Enrollment ID: I20230411000702 |
| Provider Name | Jessica Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457093502 PECOS PAC ID: 5395100416 Enrollment ID: I20230425001262 |
| Provider Name | Tyler Anderson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356633143 PECOS PAC ID: 1557653839 Enrollment ID: I20230428002301 |
| Provider Name | Anuhea Taylor Wall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235899691 PECOS PAC ID: 1355734161 Enrollment ID: I20230512001444 |
| Provider Name | Amy Pollard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477855120 PECOS PAC ID: 4880050996 Enrollment ID: I20230516001630 |
| Provider Name | Eliza Rachelle Gedge |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003197658 PECOS PAC ID: 2961868849 Enrollment ID: I20230518002645 |
| Provider Name | Daniel Stewart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639344971 PECOS PAC ID: 4880050574 Enrollment ID: I20230523001517 |
| Provider Name | Beccah Joy Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336638600 PECOS PAC ID: 0244697753 Enrollment ID: I20230526001426 |
| Provider Name | Isaac Taylor Strong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497478697 PECOS PAC ID: 4688030091 Enrollment ID: I20230530002425 |
| Provider Name | Ericka Marchelle Hickman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720382450 PECOS PAC ID: 7214394048 Enrollment ID: I20230608002995 |
| Provider Name | Hanna Heiner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952786808 PECOS PAC ID: 6002273893 Enrollment ID: I20230609001983 |
| Provider Name | Jenifer Lyn Griffin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962059642 PECOS PAC ID: 4183081821 Enrollment ID: I20230612000667 |
| Provider Name | Taylor Adelle Leduc |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497398853 PECOS PAC ID: 6507224144 Enrollment ID: I20230614001781 |
| Provider Name | Brigham Joel Fosson |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1497329858 PECOS PAC ID: 4082074042 Enrollment ID: I20230721002537 |
| Provider Name | Kendra Blinzinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093389702 PECOS PAC ID: 2860854973 Enrollment ID: I20230821003109 |
| Provider Name | Derek Benjamin Carmack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730653254 PECOS PAC ID: 4789047804 Enrollment ID: I20230822004113 |
| Provider Name | Linda Madsen Fifita |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841899465 PECOS PAC ID: 8527421148 Enrollment ID: I20230830002327 |
| Provider Name | Leilah Hunt |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1881381721 PECOS PAC ID: 8628431079 Enrollment ID: I20230831003954 |
| Provider Name | Andrew Lindsay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477003259 PECOS PAC ID: 8729442199 Enrollment ID: I20230919000809 |
| Provider Name | Robert Gavin Telford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740761071 PECOS PAC ID: 1951756485 Enrollment ID: I20231018001701 |
| Provider Name | Robert Joel Bush |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1003070111 PECOS PAC ID: 5799199592 Enrollment ID: I20231020000966 |
| Provider Name | Angela Binks Dean |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518329333 PECOS PAC ID: 5597111526 Enrollment ID: I20231027001735 |
| Provider Name | Sarah Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841816774 PECOS PAC ID: 4981051232 Enrollment ID: I20231108003175 |
| Provider Name | Janene Hwei-chang Candalot |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649373259 PECOS PAC ID: 4486002052 Enrollment ID: I20231121002423 |
| Provider Name | Derek Larsen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1679950166 PECOS PAC ID: 5890143382 Enrollment ID: I20231121003585 |
| Provider Name | Eric Gordon Crews |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1861793846 PECOS PAC ID: 9638527674 Enrollment ID: I20231130002802 |
| Provider Name | Kenneth Mcgee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427438076 PECOS PAC ID: 4284083585 Enrollment ID: I20231212002896 |
| Provider Name | David Skiles |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1003387242 PECOS PAC ID: 1052761194 Enrollment ID: I20240102001523 |
| Provider Name | Samuel L Ashton |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1144321779 PECOS PAC ID: 1557711629 Enrollment ID: I20240102002499 |
| Provider Name | Gina M Zupan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205470366 PECOS PAC ID: 5496105595 Enrollment ID: I20240102003578 |
| Provider Name | Tess Nicole Shafer |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1437526886 PECOS PAC ID: 1557711553 Enrollment ID: I20240102004112 |
| Provider Name | Phillip J Beehler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053651844 PECOS PAC ID: 8022468073 Enrollment ID: I20240103001452 |
| Provider Name | Phillip Clifton Sorenson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1174048920 PECOS PAC ID: 1254782238 Enrollment ID: I20240104001440 |
| Provider Name | Karen Ileen Carter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386947513 PECOS PAC ID: 6002267085 Enrollment ID: I20240104001679 |
| Provider Name | Robert Stark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215197405 PECOS PAC ID: 0244681906 Enrollment ID: I20240105004036 |
| Provider Name | Monte Solomon Memmott |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205928504 PECOS PAC ID: 2860843356 Enrollment ID: I20240109003326 |
| Provider Name | Dale J. Harris |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1447414743 PECOS PAC ID: 6002267325 Enrollment ID: I20240110004038 |
| Provider Name | Bryant Devaughn Jenks |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1548363864 PECOS PAC ID: 7810348141 Enrollment ID: I20240110004089 |
| Provider Name | April Knight |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1104367259 PECOS PAC ID: 3274984448 Enrollment ID: I20240111004515 |
| Provider Name | Rafael Alexander Ibarra |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134426059 PECOS PAC ID: 5496107534 Enrollment ID: I20240115000208 |
| Provider Name | Jake Neal Harper |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1184177750 PECOS PAC ID: 7315399334 Enrollment ID: I20240116001061 |
| Provider Name | Chad J Shubin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1467646901 PECOS PAC ID: 1658723606 Enrollment ID: I20240116001883 |
| Provider Name | Lesa H Carter |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1356521702 PECOS PAC ID: 0840642716 Enrollment ID: I20240116002944 |
| Provider Name | Thora Elisebeth Lieby Moore |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1386290054 PECOS PAC ID: 4486006392 Enrollment ID: I20240116003920 |
| Provider Name | Judy E Ceccherini |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1598094187 PECOS PAC ID: 3779935598 Enrollment ID: I20240117003176 |
| Provider Name | Richard Jason Sauque |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699048959 PECOS PAC ID: 3971955204 Enrollment ID: I20240122004587 |
| Provider Name | Caroline Marie Graham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114563681 PECOS PAC ID: 4284086406 Enrollment ID: I20240124003082 |
| Provider Name | Lena Marie Rasmussen Daily |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518375666 PECOS PAC ID: 3375996473 Enrollment ID: I20240124004775 |
| Provider Name | Matthew Januzik |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376187898 PECOS PAC ID: 8820441942 Enrollment ID: I20240125000482 |
| Provider Name | Devin Patrick Monahan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043559594 PECOS PAC ID: 9537512561 Enrollment ID: I20240126000030 |
| Provider Name | Marlene Sisson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033584644 PECOS PAC ID: 4284087669 Enrollment ID: I20240201002470 |
| Provider Name | Allen Stewart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649478470 PECOS PAC ID: 2264580059 Enrollment ID: I20240208001030 |
| Provider Name | Jordan Robert Gray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235414350 PECOS PAC ID: 9133563018 Enrollment ID: I20240219003423 |
| Provider Name | Neal Reese |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740651504 PECOS PAC ID: 2163866054 Enrollment ID: I20240219003792 |
| Provider Name | Lauren Mckinnon Castro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972959138 PECOS PAC ID: 8921442708 Enrollment ID: I20240220003310 |
| Provider Name | Janiece Munroe Byers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134597487 PECOS PAC ID: 1153766225 Enrollment ID: I20240228002344 |
| Provider Name | Karen A Millett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134378334 PECOS PAC ID: 2567808942 Enrollment ID: I20240307002048 |
| Provider Name | Shannon Cayer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295229466 PECOS PAC ID: 3274979463 Enrollment ID: I20240311001192 |
| Provider Name | Robin Paul Shepley |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1861720567 PECOS PAC ID: 7315384864 Enrollment ID: I20240320002089 |
| Provider Name | Wai Yan Ng |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407504657 PECOS PAC ID: 9133566573 Enrollment ID: I20240321001563 |
| Provider Name | Kathryn Lael Owen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023755980 PECOS PAC ID: 6103263207 Enrollment ID: I20240325003932 |
| Provider Name | Carl Barry Sanford |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457654873 PECOS PAC ID: 2668810458 Enrollment ID: I20240328003423 |
| Provider Name | Tresa B. Heaton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477148021 PECOS PAC ID: 8820437700 Enrollment ID: I20240412000440 |
| Provider Name | Amy Nichole Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750783783 PECOS PAC ID: 0345680336 Enrollment ID: I20240424001088 |
| Provider Name | Jarle Zenoa Meservy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912952284 PECOS PAC ID: 5799709622 Enrollment ID: I20240515002955 |
| Provider Name | Rachel Higgins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083389258 PECOS PAC ID: 6608217823 Enrollment ID: I20240517002961 |
Wasatch Mental Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 750 N Freedom Blvd, Provo, UT 84601 Phone: 801-373-4760 | |
Douglas Wendt Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1869 N 1120 W, Provo, UT 84604 Phone: 385-273-7250 | |
Preferred Family Clinic Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1355 N University Ave Ste 200, Provo, UT 84604 Phone: 801-221-0223 Fax: 801-221-0291 | |
Xlr8 Therapy Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1509 N 2100 W, Provo, UT 84604 Phone: 801-400-8510 | |
Imperial Healing Estate Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4194 Imperial Way, Provo, UT 84604 Phone: 385-312-0352 | |
Gold Plus Therapy Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 180 N University Ave Ste 270, Provo, UT 84601 Phone: 404-482-2686 | |
Lighthouse Trauma Therapy Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 883 S 1540 E, Provo, UT 84606 Phone: 801-829-1311 |