Healthcare Provider Details

I. General information

NPI: 1790595924
Provider Name (Legal Business Name): DONNY AT WELLBRIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/07/2025
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

VIII. Authorized Official

Name: DONALD SMITH
Title or Position: OWNER
Credential: LCSW
Phone: 801-609-4561