Healthcare Provider Details

I. General information

NPI: 1447108949
Provider Name (Legal Business Name): VIDA UTAH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8813 S REDWOOD RD STE B1
WEST JORDAN UT
84088-9272
US

IV. Provider business mailing address

8813 S REDWOOD RD STE B1
WEST JORDAN UT
84088-9272
US

V. Phone/Fax

Practice location:
  • Phone: 385-439-9823
  • Fax:
Mailing address:
  • Phone: 385-439-9823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RENE E. BARRERA
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 385-247-8387