Provider Demographics
NPI:1922734391
Name:MINDFUL MENTAL HEALTH OF UTAH LLC
Entity Type:Organization
Organization Name:MINDFUL MENTAL HEALTH OF UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:853-350-1081
Mailing Address - Street 1:3976 SILVERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GREEN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9724
Mailing Address - Country:US
Mailing Address - Phone:801-648-7530
Mailing Address - Fax:801-648-7493
Practice Address - Street 1:3976 SILVERSTONE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GREEN
Practice Address - State:UT
Practice Address - Zip Code:84050-9724
Practice Address - Country:US
Practice Address - Phone:801-648-7530
Practice Address - Fax:801-648-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty