Wasatch Behavioral Health Special Service District
Organization Active NPI Clinical Medical Laboratory · Orem, UT
NPI 1669257556 · NPPES record last updated Jul 18, 2025
Key facts
- NPI
- 1669257556
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Legal business name
- WASATCH BEHAVIORAL HEALTH SPECIAL SERVICE DISTRICT
- Practice address
- 255 S Orem Blvd
Orem, UT 84058-3009 - Phone
- (801) 373-4760
- NPI assigned
- Aug 29, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- WASATCH BEHAVIORAL HEALTH SPECIAL SERVICE DISTRICT
Authorized official
- Name
- Juergen E Korbanka, PH.D.
- Title
- Executive Director
- Phone
- (801) 852-4703
Parent organization (reported in NPPES) 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 208
-
Samuel L Ashton, MFTI
-
David Troy Blume, LCSW
-
Page Marc Bowler, CSW
-
Amy Buehler, LCSW
-
Robert Joel Bush, M.D.
-
Brian Wayne Butler, LCSW
-
Janiece Munroe Byers, LCSW
-
Derek Benjamin Carmack, CPSS, CSW
-
Monte N Criddle Jr., LMFT
-
Jeffrey Marvin Dalley, LCSW
-
Dallas Lane Earnshaw, APRN, CNS, BC
-
Elizabeth Feil, LCSW MSW
-
Brigham Joel Fosson, APRN
-
Alexander C. Gray, CSW
-
Jordan Robert Gray, PRO. COUNSELOR
-
Melissa Sue Guest, NURSE PRACTITIONER
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D2195540 | Wasatch Behavioral Health | Compliance | Apr 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250110002267 | UT | Part B Supplier - Independent Clinical Laboratory | 2567367915 | Practice locations: Orem, UT |
National Provider Directory
- Tax ID family
- Fuller Psychological and Family Services
- Part of
- Fuller Psychological and Family Services
Locations
255 S Orem Blvd
Orem, UT 84058
Phone (385) 268-5000
225 S Orem Blvd
Orem, UT 84058
Phone (385) 368-5000
921 N 1240 E
Orem, UT 84097
Phone (435) 650-1931
1157 E 300 N
Provo, UT 84606
Phone (801) 373-7443
151 S University Ave
Ste 1400
Provo, UT 84601
Phone (801) 851-7127
580 E 600 S
Provo, UT 84606
Phone (801) 373-7443
1189 E 300 N
Provo, UT 84606
Phone (801) 373-2215
151 S University Ave
Ste 1200
Provo, UT 84601
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
255 S Orem Blvd
Orem, UT 84058-3009
Mailing address
750 N Freedom Blvd Ste 300
Provo, UT 84601-1690
Phone (801) 374-4760
Other names
- Wasatch Behavioral Health Special Service District Laboratory
Other providers in Orem, UT
- Simon Phillip Warner
- Connie Louise Warr
- Warren a Peterson, D.O.
- Warren RX Enterprises Inc
- Dawn Raine Wartz
- Wasatch Foot and Ankle Specialists LLC
- Wasatch Medical Center
- Wasatch Mental Health
- Wasatch Neonatal LC
- Sarah Kelly Wasden
All providers in Orem, UT · Clinical Medical Laboratory in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.