MEDICARE: VIDA UTAH INC.

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	:	1447108949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA UTAH INC.

Provider Business Mailing Address
First Line	:	8813 S REDWOOD RD STE B1
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9272
Country	:	US
Telephone Number	:	385-439-9823
Fax Number	:

Provider Business Practice Location Address
First Line	:	8813 S REDWOOD RD STE B1
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9272
Country	:	US
Telephone Number	:	385-439-9823
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	RENE E. BARRERA
Credential	:	LCSW
Telephone Number	:	385-247-8387

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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