Healthcare Provider Details

I. General information

NPI: 1033558697
Provider Name (Legal Business Name): UTAH HEALING CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E VINE ST
MURRAY UT
84107-7904
US

IV. Provider business mailing address

45 E VINE ST
MURRAY UT
84107-7904
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-4643
  • Fax: 801-266-4775
Mailing address:
  • Phone: 801-266-4643
  • Fax: 801-266-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. JANELLE NIMER
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: PH.D., LCSW
Phone: 801-266-4643