Healthcare Provider Details

I. General information

NPI: 1457216335
Provider Name (Legal Business Name): NEURVANA PSYCHIATRY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 S CENTER VIEW CT #6290
WEST JORDAN UT
84084
US

IV. Provider business mailing address

50 W BROADWAY STE 333
SALT LAKE CITY UT
84101-2027
US

V. Phone/Fax

Practice location:
  • Phone: 385-329-7410
  • Fax:
Mailing address:
  • Phone: 385-329-7410
  • 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: ALLISON BONHAM
Title or Position: OWNER
Credential: PMHNP
Phone: 385-329-7410