Provider Demographics
NPI:1659084879
Name:WHOLE MIND LLC
Entity Type:Organization
Organization Name:WHOLE MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-477-7189
Mailing Address - Street 1:770 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2293
Mailing Address - Country:US
Mailing Address - Phone:801-477-7189
Mailing Address - Fax:
Practice Address - Street 1:1064 S NORTH COUNTY BLVD STE 385
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3427
Practice Address - Country:US
Practice Address - Phone:801-477-7189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty