Provider Demographics
NPI:1023627759
Name:WASATCH FRONT WELLNESS, PLLC
Entity type:Organization
Organization Name:WASATCH FRONT WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIFAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:385-244-0055
Mailing Address - Street 1:940 N 400 E STE 3
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-1945
Mailing Address - Country:US
Mailing Address - Phone:385-244-0055
Mailing Address - Fax:385-240-2065
Practice Address - Street 1:940 N 400 E STE 3
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-1945
Practice Address - Country:US
Practice Address - Phone:385-244-0055
Practice Address - Fax:385-240-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty