Healthcare Provider Details

I. General information

NPI: 1245504265
Provider Name (Legal Business Name): COMPASSPOINTE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 W 5300 S
MURRAY UT
84123-5671
US

IV. Provider business mailing address

689 W. 5300 S.
MURRAY UT
84123
US

V. Phone/Fax

Practice location:
  • Phone: 801-904-2198
  • Fax: 801-904-2254
Mailing address:
  • Phone: 801-904-2198
  • Fax: 801-904-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number18860
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number18860
License Number StateUT

VIII. Authorized Official

Name: MR. RONALD D. JENSEN
Title or Position: CLINIC DIRECTOR
Credential: LCSW
Phone: 801-904-2198