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General NPI Number Information
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NPI Number | 1659084879
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Entity Type | Organization
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Legal Business Name | WHOLE MIND LLC
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 1221 S VALLEY GROVE WAY STE 160
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-6758
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Country | US
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Telephone | 801-815-3106
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 S VALLEY GROVE WAY STE 160
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-6758
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Country | US
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Telephone | 801-477-7189
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. THOMAS ALLEN RAYNER
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Credential | MD
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Telephone | 801-815-3106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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