NPIMap

Organization Active NPI

Blue Willow Psychiatry

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tooele, UT
National Provider Identifier
1366397697
Registry record updated Mar 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
BLUE WILLOW PSYCHIATRY
Practice address
40A S Main St
Tooele, UT 84074-2132
Phone
(435) 200-3430
Fax
(855) 450-1174
NPI assigned
Mar 2, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2026

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

Authorized official

Name
Kristi Lynn LawrenceNPI 1811349780
Title
Owner
Phone
(435) 200-3430

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

40A S Main St
Tooele, UT 84074-2132

Mailing address

67 N Center St
Grantsville, UT 84029-9605

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1772409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773100800000",
    "number": "1366397697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 N CENTER ST",
            "city": "GRANTSVILLE",
            "state": "UT",
            "postal_code": "840299605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40A S MAIN ST",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840742132",
            "telephone_number": "435-200-3430",
            "fax_number": "855-450-1174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WILLOW PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-02",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-200-3430"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tooele, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.