Healthcare Provider Details

I. General information

NPI: 1376822833
Provider Name (Legal Business Name): NEXSTEP MEDICAL DETOX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 E 800 N
OREM UT
84097-4314
US

IV. Provider business mailing address

PO BOX 1377
OREM UT
84059-1377
US

V. Phone/Fax

Practice location:
  • Phone: 801-607-1189
  • Fax: 801-607-1279
Mailing address:
  • Phone: 801-607-1189
  • Fax: 801-607-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: LENNY MARETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 801-607-1189