NPIMap

Skyler Elden Clark

Individual provider Active NPI Marriage & Family Therapist · Mapleton, UT

NPI 1548993645 · NPPES record last updated Oct 20, 2023

Key facts

NPI
1548993645
Entity type
Individual (NPI type 1)
Primary specialty
Marriage & Family Therapist 106H00000X
License
13542811-3904 (UT)
Practice address
774 S 1600 W Ste 101
Mapleton, UT 84664-4346
Phone
(801) 407-4134
Fax
(801) 877-0684
NPI assigned
Jul 6, 2022
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

  • Sela Health, PLLC Mental Health Clinic/Center (Including Community Mental Health Center) · Provo, UT · NPI 1497183024
    NPD (past) MARRIAGE & FAMILY THERAPIST

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
13542811-3904UTMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sela Health, PLLC Marriage & Family Therapist Past
since Oct 22, 2023		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 13542811-3904 UT Yes

Addresses

Primary practice location

774 S 1600 W Ste 101
Mapleton, UT 84664-4346

Mailing address

PO Box 50207
Provo, UT 84605-0207
Phone (801) 407-4134

Other practice location 1

4626 N 300 W Ste 150
Provo, UT 84604-6077
Phone (801) 407-4134

Other providers in Mapleton, UT

All providers in Mapleton, UT · Marriage & Family Therapist in Utah

Sources for this page

Verify at the official NPI Registry.