MEDICARE: PROMIND PSYCHIATRY

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1497607071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMIND PSYCHIATRY

Provider Business Mailing Address
First Line	:	777 E 4500 S STE 240
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-3067
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 E 4500 S STE 240
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-3067
Country	:	US
Telephone Number	:	801-382-8118
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	ANTHONY PRIVRATSKY
Credential	:	MD
Telephone Number	:	832-656-9485

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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Directions to “PROMIND PSYCHIATRY ” Practice Location

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