BONNEVILLE MENTAL HEALTH, PLLC (NPI# 1902236458) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902236458 |
| Entity Type | Organization |
| Organization Name | BONNEVILLE MENTAL HEALTH, PLLC |
| Practice Address |
134 W 1180 N Ste 4 Tooele UT 84074-1483 |
| Practice Telephone | 4352284181 |
| Mailing Telephone | 4352284181 |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2016-05-10 |
| Authorized Official Name | NATE GREEN (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 4352284181 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
2903 | UT | Ambulatory Health Care Facilities |
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
2903 | UT | Ambulatory Health Care Facilities |
| Street Address |
134 W 1180 N STE 4 |
| City | TOOELE |
| State | UT |
| Zip Code | 84074-1483 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649482803 | Alternative Choices | Community/Behavioral Health | 134 W 1180 N Ste 4, Tooele, UT 84074-1483 | 2007-05-03 |
| 1275961781 | Bonneville Mental Health | Clinic/Center | 134 W 1180 N Ste 4, Tooele, UT 84074-1483 | 2013-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689233397 | Leah Elizabeth Harper I | Behavior Technician | 39 Millpond Stansbury Park, Tooele, UT 84074 | 2019-06-07 |
| 1245710789 | Tanna Marie Shelley | Community Health Worker | 27 So Main St, Tooele, UT 84074 | 2018-08-15 |
| 1528548062 | Barbara T Cederlof | Community Health Worker | 27 South Main St., Tooele, UT 84074 | 2018-08-15 |
| 1235615600 | Ashley Christine Wilson | Case Manager/Care Coordinator | 27 South Main, Tooele, UT 84074 | 2018-07-18 |
| 1174016976 | Makenzie Green | Case Manager/Care Coordinator | 27 S Main, Tooele, UT 84074 | 2018-06-07 |
| 1386151835 | Monica Lee | Physical Therapist | 6727 Ut-36 #300, Stansbury Park, UT 84074 | 2018-01-05 |
| 1871976183 | Pagnani Physical Therapy | Physical Therapist | 6727 North State Hwy 36, Suite 300, Stansbury Park, UT 84074 | 2015-07-06 |
| 1407248222 | Pebble Creek Counseling Center | Counselor | 494 E 2400 N Ste B, Tooele, UT 84074 | 2015-03-03 |
| 1528496221 | Emily Carlson | Case Manager/Care Coordinator | 220 North Millpond Rd, Suite 100, Stansbury Park, UT 84074 | 2013-10-16 |
| 1710327218 | Angela Michelle Demoss | Nurse Practitioner | 682 Country Club, Stansbury Park, UT 84074 | 2013-06-28 |
| Find all providers in zip 84074 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255943569 | Skull Valley Health Care | Clinic/Center | 1929 N Aaron Dr, Tooele, UT 84074-8112 | 2020-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003427923 | Painted Desert Recovery LLC | Clinic/Center | 1947 S 2800 E, New Harmony, UT 84757-5115 | 2020-08-13 |
| 1437780673 | Beecon Recovery | Clinic/Center | 60 S Main St Ste B0001, Brigham City, UT 84302-6795 | 2020-01-27 |
| 1124666870 | One Voice Recovery | Clinic/Center | 1400 S 1100 E, Salt Lake City, UT 84105-2435 | 2019-12-12 |
| 1992343834 | Avante Recovery Center, LLC | Clinic/Center | 848 E 1475 N, Lehi, UT 84043-3568 | 2019-12-11 |
| 1467912139 | Infinite Arches LLC | Clinic/Center | 136 25th St, Ogden, UT 84401-1302 | 2019-03-20 |
| 1669952958 | Utah Harm Reduction Coalition | Clinic/Center | 91 E 7200 S, Midvale, UT 84047-1531 | 2018-08-16 |
| 1871016840 | Breakaway Recovery Center Murray, LLC | Clinic/Center | 5296 S Commerce Dr Ste 204, Murray, UT 84107-5393 | 2017-07-21 |
| 1528580180 | Brighton House LLC | Clinic/Center | 2945 E Robidoux Rd, Sandy, UT 84093-1128 | 2017-07-14 |
| 1316392897 | Nuway Recovery, LLC | Clinic/Center | 4925 S 900 E, Salt Lake City, UT 84117-5784 | 2016-05-03 |
| 1578917787 | Deer Hollow Outpatient Services, LLC | Clinic/Center | 12608 S 125 W Ste E, Draper, UT 84020-8437 | 2016-04-14 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on BONNEVILLE MENTAL HEALTH, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.