Provider Demographics
NPI:1598360125
Name:MOUNTAIN WEST BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MOUNTAIN WEST BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-860-0625
Mailing Address - Street 1:3570 W 9000 S STE 140
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8839
Mailing Address - Country:US
Mailing Address - Phone:801-860-0625
Mailing Address - Fax:
Practice Address - Street 1:3570 W 9000 S STE 140
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8839
Practice Address - Country:US
Practice Address - Phone:801-860-0625
Practice Address - Fax:385-707-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1396148896Medicaid