Youth Care of Utah, Inc.

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

License

12293, 12294, 12295 Issued in UT

Legal business name

YOUTH CARE OF UTAH, INC.

Practice address

12595 Minuteman Dr
Draper, UT 84020-9541

Phone

(801) 572-6989

Fax

(801) 572-8220

NPI assigned

Jan 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Trina Packard

Title

Executive Director

Phone

(801) 572-6989

Specialties & licenses 1

Addresses

Other names 1

• Pine Ridge Academy Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard Wayne Mickelsen, M.D.

  • Child & Adolescent Psychiatry Physician
  • Provo, UT
  • NPI 1740250372
  NPD (past)
• Amanda Thomas, FNP, APRN

  • Family Nurse Practitioner
  • Orem, UT
  • NPI 1922709047
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083767297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840200909",
            "telephone_number": "801-572-6989",
            "fax_number": "801-572-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12595 MINUTEMAN DR",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840209541",
            "telephone_number": "801-572-6989",
            "fax_number": "801-572-8220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH CARE OF UTAH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PACKARD",
        "authorized_official_first_name": "TRINA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-572-6989",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "UT",
            "license": "12293, 12294, 12295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Ridge Academy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kaylee Young
• Melissa Young
• Morgan Young
• Ryan Young, PHARM D
• Hailey Youngblood
• Megan Zajonc
• Michael Zander
• David Zane, LCMHC
• Dorina Zavala
• Galilea Zavala

• Psychiatric Residential Treatment Facility in Draper, UT
• Providers in Draper, UT by specialty
• Psychiatric Residential Treatment Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.