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General NPI Number Information
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NPI Number | 1922734391
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Entity Type | Organization
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Legal Business Name | MINDFUL MENTAL HEALTH OF UTAH LLC
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 3976 SILVERSTONE RD
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City | MOUNTAIN GREEN
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State | UT
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Zip | 84050-9724
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Country | US
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Telephone | 801-648-7530
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Fax | 801-648-7493
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Provider Business Mailing Address
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Address Line | 3976 SILVERSTONE RD
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City | MOUNTAIN GREEN
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State | UT
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Zip | 84050-9724
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Country | US
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Telephone | 801-648-7530
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Fax | 801-648-7493
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Authorized Official
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Title or Position | CO-OWNER
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Name | BLAINE MURRAY
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Credential |
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Telephone | 853-350-1081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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