Healthcare Provider Details

I. General information

NPI: 1174417372
Provider Name (Legal Business Name): WHOLE MIND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SAN MARIN DR STE B150
NOVATO CA
94945-1362
US

IV. Provider business mailing address

1221 S VALLEY GROVE WAY STE 160
PLEASANT GROVE UT
84062-6758
US

V. Phone/Fax

Practice location:
  • Phone: 801-477-7189
  • Fax: 888-745-9274
Mailing address:
  • Phone: 801-477-7189
  • Fax: 888-745-9274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS RAYNER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 801-477-7189