Healthcare Provider Details

I. General information

NPI: 1306010574
Provider Name (Legal Business Name): CLINICAL CONSULTANTS LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 SOUTH REDWOOD ROAD BUILDING E
WEST JORDAN UT
84084-9323
US

IV. Provider business mailing address

7601 S REDWOOD RD BLDG E
WEST JORDAN UT
84084-4007
US

V. Phone/Fax

Practice location:
  • Phone: 801-233-8670
  • Fax: 801-233-8682
Mailing address:
  • Phone: 801-233-8670
  • Fax: 801-233-8682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number16640
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number16640
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL VREDENBURG
Title or Position: ADMINISTRATIVE COORDINATOR
Credential:
Phone: 801-233-8670