Healthcare Provider Details

I. General information

NPI: 1427979202
Provider Name (Legal Business Name): WHITE OAK WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 W 300 N STE 4
HYDE PARK UT
84318-4044
US

IV. Provider business mailing address

338 W 300 N
HYDE PARK UT
84318-4044
US

V. Phone/Fax

Practice location:
  • Phone: 435-227-5756
  • Fax:
Mailing address:
  • Phone: 435-227-5756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ERIN BLACK
Title or Position: OWNER/PROVIDER
Credential: LCSW
Phone: 435-512-5686