Healthcare Provider Details

I. General information

NPI: 1235018854
Provider Name (Legal Business Name): MENTELE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 S 1000 W
MAPLETON UT
84664-4918
US

IV. Provider business mailing address

3417 S 1000 W
MAPLETON UT
84664-4918
US

V. Phone/Fax

Practice location:
  • Phone: 208-860-9370
  • Fax:
Mailing address:
  • Phone: 208-860-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM HANSEN
Title or Position: CEO
Credential: LCPC, CMHC
Phone: 208-860-9370