Healthcare Provider Details

I. General information

NPI: 1841917218
Provider Name (Legal Business Name): BRIGHT MINDS DEVELOPMENTAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 E 2900 S
VERNAL UT
84078-8858
US

IV. Provider business mailing address

422 E 2900 S
VERNAL UT
84078-8858
US

V. Phone/Fax

Practice location:
  • Phone: 801-602-9160
  • Fax:
Mailing address:
  • Phone: 801-602-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUSTIN AARON BENSON
Title or Position: OWNER
Credential: M.ED., CCC-SLP
Phone: 801-602-9160