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General NPI Number Information
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NPI Number | 1770482804
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Entity Type | Organization
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Legal Business Name | PROMISE HEALTH & WELLNESS
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 1700 S SHANGRILA # 100
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City | TOQUERVILLE
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State | UT
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Zip | 84774-5039
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Country | US
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Telephone | 800-343-3438
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Fax | 877-698-4968
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Provider Business Mailing Address
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Address Line | 1700 S SHANGRILA # 100
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City | TOQUERVILLE
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State | UT
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Zip | 84774-5039
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Country | US
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Telephone | 800-343-3438
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Fax | 877-698-4968
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TYLER OLSEN
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Credential |
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Telephone | 801-890-5342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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