Healthcare Provider Details

I. General information

NPI: 1164379459
Provider Name (Legal Business Name): MILLCREEK MIND AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4578 S HIGHLAND DR STE 250
MILLCREEK UT
84117-4200
US

IV. Provider business mailing address

3080 S 2075 E
SALT LAKE CITY UT
84109-2415
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-5009
  • Fax:
Mailing address:
  • Phone: 801-871-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY PERRY
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C, CAQ-PSYCH
Phone: 801-750-4716