Organization · NPI-2

Great Salt Lake Wellness INC

Psychologist, Clinical · Kaysville, UT

NPI number1790152940
StatusActive
Last updated in NPPESApr 17, 2024

Details

NPI
1790152940
Entity type
Organization (NPI-2)
Legal business name
Great Salt Lake Wellness INC
Organization subpart
No
Enumeration date
Aug 24, 2015
Certification date
Apr 17, 2024
Last updated
Apr 17, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103TC0700X Psychologist, Clinical7510289-2501UTYes

Practice location

375 N Main St Ste 202
Kaysville, UT 84037-1278

Phone 801-844-1615 · Fax 801-825-1162

Mailing address

375 N Main St Ste 202
Kaysville, UT 84037-1278

Phone 801-844-1615 · Fax 385-209-2975

Authorized official

Emily Young Bullock
Owner
8013899521

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