Healthcare Provider Details

I. General information

NPI: 1285516575
Provider Name (Legal Business Name): CARLTON GREG BAXTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S 100 E STE 300
PAYSON UT
84651-2253
US

IV. Provider business mailing address

95 S 100 E STE 300
PAYSON UT
84651-2253
US

V. Phone/Fax

Practice location:
  • Phone: 801-382-9338
  • Fax:
Mailing address:
  • Phone: 801-382-9338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13416798-6009
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13416798-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: