Provider Demographics
NPI:1093447757
Name:WESTERN WELLNESS LLC
Entity Type:Organization
Organization Name:WESTERN WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:385-313-0547
Mailing Address - Street 1:S1222 MATHISON LN
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667-7266
Mailing Address - Country:US
Mailing Address - Phone:385-313-0547
Mailing Address - Fax:
Practice Address - Street 1:370 E SOUTH TEMPLE STE 550
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1237
Practice Address - Country:US
Practice Address - Phone:385-313-0547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)