Healthcare Provider Details

I. General information

NPI: 1366301079
Provider Name (Legal Business Name): WILLOW PINES THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 W 2600 S STE 200
BOUNTIFUL UT
84010-7780
US

IV. Provider business mailing address

124 W WENDELL WAY
FARMINGTON UT
84025-5084
US

V. Phone/Fax

Practice location:
  • Phone: 801-663-8575
  • Fax:
Mailing address:
  • Phone: 801-663-8575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIK JENKINS
Title or Position: OWNER
Credential: LCSW
Phone: 801-663-8575