Healthcare Provider Details

I. General information

NPI: 1750924304
Provider Name (Legal Business Name): TELOS NEURO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 W CENTER ST
OREM UT
84057-5202
US

IV. Provider business mailing address

870 W CENTER ST
OREM UT
84057-5202
US

V. Phone/Fax

Practice location:
  • Phone: 801-426-8800
  • Fax:
Mailing address:
  • Phone: 801-426-8800
  • 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: ANTHONY MOSIER
Title or Position: CO-OWNER
Credential: LMFT
Phone: 801-380-8830