Healthcare Provider Details

I. General information

NPI: 1184533978
Provider Name (Legal Business Name): PEREGRINE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 W CENTER ST STE N102
PLEASANT GROVE UT
84062-3360
US

IV. Provider business mailing address

10375 N BRISTLECONE WAY
CEDAR HILLS UT
84062-8540
US

V. Phone/Fax

Practice location:
  • Phone: 801-769-6219
  • Fax:
Mailing address:
  • Phone: 801-769-6219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHARELLE HAGEN
Title or Position: CLINICAL THERAPIST
Credential: LCSW
Phone: 801-769-6219