Healthcare Provider Details

I. General information

NPI: 1568320828
Provider Name (Legal Business Name): REYNIE SANDOVAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 770 N
OREM UT
84097-4101
US

IV. Provider business mailing address

853 N 1200 E
PROVO UT
84604-3526
US

V. Phone/Fax

Practice location:
  • Phone: 801-473-8844
  • Fax:
Mailing address:
  • Phone: 801-476-8844
  • Fax:

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

VIII. Authorized Official

Name: REYNIE SANDOVAL
Title or Position: LCSW
Credential:
Phone: 801-473-8844