Healthcare Provider Details

I. General information

NPI: 1487352555
Provider Name (Legal Business Name): WELLBRIDGE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 E 930 S
OREM UT
84058-5001
US

IV. Provider business mailing address

247 E 930 S
OREM UT
84058-5001
US

V. Phone/Fax

Practice location:
  • Phone: 801-609-4561
  • Fax: 801-797-0254
Mailing address:
  • Phone: 801-609-4561
  • Fax: 801-797-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMIS LEEPER
Title or Position: PARTNER
Credential: DNP, APRN, PMHNP-BC
Phone: 801-609-4561