Healthcare Provider Details

I. General information

NPI: 1003568247
Provider Name (Legal Business Name): A MIND'S JOURNEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9678 SOUTH 700 EAST SUITE 101, 201
SANDY UT
84070-8407
US

IV. Provider business mailing address

PO BOX 1847
SANDY UT
84091-1847
US

V. Phone/Fax

Practice location:
  • Phone: 801-589-9965
  • Fax: 801-665-0433
Mailing address:
  • Phone: 801-589-9965
  • Fax: 801-665-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CORY SPEAKER
Title or Position: CO-OWNER
Credential:
Phone: 801-808-5421