Provider Demographics
NPI:1598440984
Name:EXPERIENCE MENTAL WELLNESS LLC
Entity Type:Organization
Organization Name:EXPERIENCE MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-312-0787
Mailing Address - Street 1:1461 E 840 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-5486
Mailing Address - Country:US
Mailing Address - Phone:385-312-0787
Mailing Address - Fax:
Practice Address - Street 1:1461 E 840 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-5486
Practice Address - Country:US
Practice Address - Phone:385-312-0787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty