MEDICARE: VERBENA WELLNESS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1407625346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERBENA WELLNESS

Provider Business Mailing Address
First Line	:	6145 S 520 E
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-7442
Country	:	US
Telephone Number	:	801-866-9034
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 S 600 E STE 3A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1961
Country	:	US
Telephone Number	:	801-866-9034
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	LINDSEY ANN MACFARLANE
Credential	:	LCSW
Telephone Number	:	801-866-9034

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	12/20/2023

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