Healthcare Provider Details

I. General information

NPI: 1417844671
Provider Name (Legal Business Name): OUTDOOR TALK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E 1650 S
BOUNTIFUL UT
84010
US

IV. Provider business mailing address

7533 S CENTER VIEW CT # 5130
WEST JORDAN UT
84084-5526
US

V. Phone/Fax

Practice location:
  • Phone: 479-670-1019
  • Fax:
Mailing address:
  • Phone: 479-670-1019
  • 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
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALBERT CHAD MEYNDERS
Title or Position: FOUNDER & CEO
Credential: MBA
Phone: 479-670-1019