Healthcare Provider Details

I. General information

NPI: 1104578988
Provider Name (Legal Business Name): ROCKY TOP MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 01/22/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N STATE ST
OREM UT
84057-4747
US

IV. Provider business mailing address

309 N STATE ST
OREM UT
84057-4747
US

V. Phone/Fax

Practice location:
  • Phone: 801-369-4856
  • Fax: 801-434-8333
Mailing address:
  • Phone: 801-369-4856
  • Fax: 801-434-8333

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: RICHARD C TRIPP
Title or Position: OWNER/OPERATOR
Credential: CMHC
Phone: 801-369-4856