Healthcare Provider Details

I. General information

NPI: 1013385244
Provider Name (Legal Business Name): BENJAMIN YOUNG CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 S 680 W
PAYSON UT
84651-5112
US

IV. Provider business mailing address

1422 S 680 W
PAYSON UT
84651-5112
US

V. Phone/Fax

Practice location:
  • Phone: 801-472-2687
  • Fax:
Mailing address:
  • Phone: 801-472-2687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5545827-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: