TRAUMA CENTER OF UTAH, LLC (NPI# 1295207231) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295207231 |
| Entity Type | Organization |
| Organization Name | TRAUMA CENTER OF UTAH, LLC |
| Practice Address |
4980 N University Ave Apt 12 Provo UT 84604-6444 |
| Practice Telephone | 8016444014 |
| Mailing Telephone | 8016444014 |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2018-12-31 |
| Authorized Official Name | TONYA PORTER (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 8018515504 |
| Authorized Official Credential | LMHC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| Street Address |
4980 N UNIVERSITY AVE APT 12 |
| City | PROVO |
| State | UT |
| Zip Code | 84604-6444 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346882107 | Abigail Belle Hardy | Student in an Organized Health Care Education/Training Program | 1190 900 E, Provo, UT 84604 | 2019-10-14 |
| 1386106698 | Sarah Roseman Hunt | Nurse Practitioner | 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 | 2019-04-04 |
| 1255813325 | Hwigeum Jeong | Specialist/Technologist | Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 | 2018-09-05 |
| 1093203044 | Snowcap Smile Studio LLC | Dentist | 2230 N. University Pkwy Ste 8b, Provo, UT 84604 | 2018-04-25 |
| 1407359078 | Ihc Health Services Inc | Clinic/Center | 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 | 2018-03-09 |
| 1902308455 | Afton Leuga | Nurse Practitioner | 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 | 2018-03-01 |
| 1851807333 | Ihc Health Services Inc | Family Medicine | 380 W 1230 N, Ste 602, Provo, UT 84604 | 2017-12-20 |
| 1689180218 | Ihc Health Services Inc | Pediatrics | 395 W Bulldog Blvd Ste 703, Provo, UT 84604 | 2017-12-19 |
| 1396254165 | Nicolas Sorensen | Massage Therapist | 247 West 2230 North #201, Provo, UT 84604 | 2017-09-25 |
| 1437692241 | Cirque Lodge Inc | Substance Abuse Rehabilitation Facility | 3114 E Ida's Road, Sundance, UT 84604 | 2016-11-28 |
| Find all providers in zip 84604 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033606298 | Imperial Healing Estate | Clinic/Center | 4194 Imperial Way, Provo, UT 84604-5328 | 2018-04-13 |
| 1821309238 | Adolescent Center for Talent Development | Clinic/Center | 633 S 550 E, Suite 220, Provo, UT 84606-5556 | 2010-06-30 |
| 1003243940 | Wasatch Mental Health | Clinic/Center | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2013-10-10 |
| 1326304023 | Life Enhancement Center | Clinic/Center | 1835 N 1120 W, Provo, UT 84604-1180 | 2012-04-06 |
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|---|---|---|---|---|
| 1013478346 | Kintsugi Counseling, LLC | Clinic/Center | 150 N Main St Ste 204, Heber City, UT 84032-1671 | 2019-03-28 |
| 1265997746 | Summit Counseling Solutions | Clinic/Center | 4838 W Pillar Dr, Riverton, UT 84096-1428 | 2019-02-08 |
| 1528534401 | Bear Creek Counseling,llc | Clinic/Center | 1227 W 9000 S Ste H, West Jordan, UT 84088-9001 | 2018-10-18 |
| 1114404704 | Monuments Academy LLC | Clinic/Center | 1990 Dry Lakes Road, Brian Head, UT 84719 | 2018-07-26 |
| 1184133571 | Connected Life Counseling Center, LLC | Clinic/Center | 741 E 9000 S Ste 200d, Sandy, UT 84094-3085 | 2017-09-28 |
| 1790229185 | Rise Above Treatment Center | Clinic/Center | 1039 S Orem Blvd, Orem, UT 84058-6979 | 2016-12-05 |
| 1699220764 | Purple Sky Counseling, Pllc | Clinic/Center | 450 W 910 S Ste 12, Heber City, UT 84032-2447 | 2016-08-18 |
| 1164898409 | Joseph K Yau Md LLC | Clinic/Center | 2215 E High Ridge Ln, Sandy, UT 84092-4860 | 2015-08-20 |
| 1447643887 | Sundance Canyon Inc | Clinic/Center | 6948 W Dusty Rose Cir, Herriman, UT 84096-4710 | 2015-03-10 |
| 1740686252 | Bridging Resilience Counseling Services | Clinic/Center | 774 E 2100 S Ste 101, Salt Lake City, UT 84106-1863 | 2014-11-10 |
| Find all providers with the same taxonomy | ||||
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| 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.