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General NPI Number Information
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NPI Number | 1366397697
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Entity Type | Organization
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Legal Business Name | BLUE WILLOW PSYCHIATRY
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Dates
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Enumeration Date | 03/02/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 40A S MAIN ST
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City | TOOELE
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State | UT
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Zip | 84074-2132
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Country | US
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Telephone | 435-200-3430
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Fax | 855-450-1174
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Provider Business Mailing Address
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Address Line | 67 N CENTER ST
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City | GRANTSVILLE
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State | UT
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Zip | 84029-9605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTI LYNN LAWRENCE
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Credential |
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Telephone | 801-554-9390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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