Healthcare Provider Details

I. General information

NPI: 1952178030
Provider Name (Legal Business Name): WASATCH TMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W 600 S STE 200
HEBER CITY UT
84032-2284
US

IV. Provider business mailing address

345 W 600 S STE 200
HEBER CITY UT
84032-2284
US

V. Phone/Fax

Practice location:
  • Phone: 801-712-3535
  • Fax:
Mailing address:
  • Phone: 801-712-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN FOGG
Title or Position: MD
Credential: MD
Phone: 801-712-2535