Organization · NPI-2

High Desert Psychology And Wellness

Clinic/Center, Mental Health (Including Community Mental Health Center) · Evanston, WY

NPI number1194226266
StatusActive
Last updated in NPPESMar 17, 2018

Details

NPI
1194226266
Entity type
Organization (NPI-2)
Legal business name
High Desert Psychology And Wellness
Organization subpart
No
Enumeration date
Feb 23, 2018
Last updated
Mar 17, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)306WYYes

Practice location

191 Overthrust Rd
Evanston, WY 82930-9261

Phone 435-631-9918

Mailing address

235 Hayden Ave
Evanston, WY 82930-5606

Phone 435-631-9918

Other practice locations

699 E South Temple
Salt Lake City, UT 84102-1142

Phone 435-631-9918

Authorized official

Adam K Fuller
President/Ceo/Clinical Director
4356319918

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