Healthcare Provider Details

I. General information

NPI: 1548906688
Provider Name (Legal Business Name): WELLNESS MINDSET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 MIDLAND DR STE 2
WEST HAVEN UT
84401-6825
US

IV. Provider business mailing address

4645 MIDLAND DR STE 2
WEST HAVEN UT
84401-6825
US

V. Phone/Fax

Practice location:
  • Phone: 801-332-9139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NATHAN BROWN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 801-332-9139