NPIMap

Organization Active NPI

Wasatch Behavioral Health Special Service District

  • Community/Behavioral Health Agency
  • Provo, UT
National Provider Identifier
1356357115
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
WASATCH BEHAVIORAL HEALTH SPECIAL SERVICE DISTRICT
Practice address
750 N Freedom Blvd
Suite 300
Provo, UT 84601
Phone
(801) 373-4760
Fax
(801) 373-0639
NPI assigned
Aug 1, 2006
Last updated
Apr 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Authorized official

Name
Mr. Doran Williams, LCSWNPI 1376500074
Title
Associate Directore
Phone
(801) 373-4760

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X UT
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

750 N Freedom Blvd
Suite 300
Provo, UT 84601

Mailing address

750 N Freedom Blvd
Suite 300
Provo, UT 84601
Phone (801) 373-4760

Other identifiers 1

IdentifierTypeStateIssuer
870285565012MedicaidUT

Other names 1

  • Wasatch Mental Health Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031129000014 UT Part B Supplier - Clinic/Group Practice 2567367915 Receives reassigned benefits from 138 practitioners
Practice locations: American Fork, UT; Spanish Fork, UT; Provo, UT; Heber City, UT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Wasatch Behavioral Health Special Service District2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

578 E 300 S
American Fork, UT 84003
Phone (801) 763-5010

1157 E 300 N
Provo, UT 84606
Phone (801) 373-7443

750 N Freedom Blvd
Ste 300
Provo, UT 84601
Phone (801) 372-4760

607 Kirby Ln
Spanish Fork, UT 84660
Phone (801) 852-3805

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 242

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 242

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1356357115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N FREEDOM BLVD",
            "address_2": "SUITE 300",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84601",
            "telephone_number": "801-373-4760",
            "fax_number": "801-373-0639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N FREEDOM BLVD",
            "address_2": "SUITE 300",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84601",
            "telephone_number": "801-373-4760",
            "fax_number": "801-373-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASATCH BEHAVIORAL HEALTH SPECIAL SERVICE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "DORAN",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTORE",
        "authorized_official_telephone_number": "801-373-4760",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "UT",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870285565012",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wasatch Mental Health",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Wasatch Mental Health",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.