| Wide Mind Wellness, Llc | |
|
11058 S Sunup Way South Jordan UT 84009-7720 | |
| (801) 520-5749 | |
| Not Available |
| Full Name | Wide Mind Wellness, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 11058 S Sunup Way, South Jordan, Utah |
| Authorized Official Name and Position | Lateisha Golub (LCSW) |
| Authorized Official Contact | 8015205749 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wide Mind Wellness, Llc 11058 S Sunup Way South Jordan UT 84009-7720 Ph: (801) 520-5749 | Wide Mind Wellness, Llc 11058 S Sunup Way South Jordan UT 84009-7720 Ph: (801) 520-5749 |
| NPI Number | 1598242893 |
|---|---|
| Provider Enumeration Date | 07/19/2018 |
| Last Update Date | 12/27/2022 |
| Certification Date | 12/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598242893 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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