Healthcare Provider Details

I. General information

NPI: 1336378769
Provider Name (Legal Business Name): NEW ROADS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 W 1130 S SUITE 145
OREM UT
84058-3833
US

IV. Provider business mailing address

1270 W 1130 S SUITE 145
OREM UT
84058-3833
US

V. Phone/Fax

Practice location:
  • Phone: 801-792-9044
  • Fax:
Mailing address:
  • Phone: 801-792-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4925186-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ERIC J SCHMIDT
Title or Position: CEO
Credential: LCSW, MBA
Phone: 801-792-9044