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General NPI Number Information
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NPI Number | 1952178030
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Entity Type | Organization
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Legal Business Name | WASATCH TMS LLC
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 345 W 600 S STE 200
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City | HEBER CITY
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State | UT
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Zip | 84032-2284
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Country | US
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Telephone | 801-712-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 345 W 600 S STE 200
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City | HEBER CITY
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State | UT
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Zip | 84032-2284
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Country | US
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Telephone | 801-712-3535
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Fax |
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Authorized Official
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Title or Position | MD
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Name | BENJAMIN FOGG
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Credential | MD
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Telephone | 801-712-2535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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