MEDICARE: ACHIEVE MENTAL 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1538758586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACHIEVE MENTAL WELLNESS

Provider Business Mailing Address
First Line	:	2666 S 2000 E STE 101
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84109-1721
Country	:	US
Telephone Number	:	801-244-3675
Fax Number	:	801-855-7998

Provider Business Practice Location Address
First Line	:	2666 S 2000 E STE 101
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84109-1721
Country	:	US
Telephone Number	:	801-244-3675
Fax Number	:	801-855-7998

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	CARLA L APPLEGATE-ANDERSON
Credential	:
Telephone Number	:	801-244-3675

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	01/14/2021

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Directions to “ACHIEVE MENTAL WELLNESS ” Practice Location

Language	Start Address	Practice Location

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