MEDICARE: DBT NETWORK OF UTAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1245897214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DBT NETWORK OF UTAH

Provider Business Mailing Address
First Line	:	9289 S REDWOOD RD STE C
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6731
Country	:	US
Telephone Number	:	801-568-2898
Fax Number	:	833-849-9902

Provider Business Practice Location Address
First Line	:	9289 S REDWOOD RD STE C
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6731
Country	:	US
Telephone Number	:	801-568-2898
Fax Number	:	833-849-9902

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTIE LEMMON
Credential	:	APRN, PMHNP-BC
Telephone Number	:	801-568-2898

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	12/13/2022

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Directions to “DBT NETWORK OF UTAH ” Practice Location

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