Healthcare Provider Details

I. General information

NPI: 1851226708
Provider Name (Legal Business Name): ANDREW BYALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

1422 E 820 N
OREM UT
84097-5481
US

V. Phone/Fax

Practice location:
  • Phone: 385-309-1038
  • Fax:
Mailing address:
  • Phone: 385-309-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR12146
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number100824
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14243665-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: