Healthcare Provider Details

I. General information

NPI: 1174447940
Provider Name (Legal Business Name): CLEAR PATH MENTAL PATH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E CENTER ST
LINDON UT
84042-2129
US

IV. Provider business mailing address

640 E CENTER ST
LINDON UT
84042-2129
US

V. Phone/Fax

Practice location:
  • Phone: 801-960-6691
  • Fax:
Mailing address:
  • Phone: 801-960-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TREVAR WILLIS WEIGHT
Title or Position: OWNER
Credential: PMHNP
Phone: 801-960-6691