Coronado Wellness LLC
Organization Active NPI Clinical Social Worker · Provo, UT
NPI 1700771995 · NPPES record last updated Feb 5, 2026
Key facts
- NPI
- 1700771995
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- CORONADO WELLNESS LLC
- Practice address
- 3507 N University Ave Ste 225
Provo, UT 84604-6635 - Phone
- (801) 960-9355
- NPI assigned
- Jun 10, 2025
- Organization subpart
- No
Authorized official
- Name
- Jamey Hughes
- Title
- Director of Operations
- Phone
- (801) 960-9355
Practitioners 15
-
Monica L. Blume, LCSW LLC
-
Rachel J Ellingson, LCSW
-
Brent Hall, LMFT
-
Laurie Coleman, MSW, LCSW
-
Lesa Koger, CSW
-
Korey Kevin Larsen, LCSW
-
Paul Weigle, PA
-
Brian Lamar Allred, LPC
-
Crystal M Davis, NP
-
David Joachim Clisbee, LCSW
-
Rachel Ellingson, MSW, LICSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL, UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250711002288 | FL | Part B Supplier - Clinic/Group Practice | 1355856196 |
Receives reassigned benefits from 1 practitioner Practice locations: St Augustine, FL |
| O20250722000931 | UT | Part B Supplier - Clinic/Group Practice | 1355856196 |
Receives reassigned benefits from 13 practitioners Practice locations: Draper, UT; Provo, UT; Springville, UT |
National Provider Directory
Locations
701 Market St
Ste 115
St Augustine, FL 32095
Phone (360) 970-2560
11576 S State St
Ste 202
Draper, UT 84020
Phone (801) 960-9355
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Clinical Social Worker |
1041C0700X | Yes | ||
| Marriage & Family Therapist |
106H00000X |
Addresses
Primary practice location
3507 N University Ave Ste 225
Provo, UT 84604-6635
Mailing address
3507 N University Ave Ste 225
Provo, UT 84604-6635
Phone (801) 960-9355
Other practice location 1
11576 S State St Ste 202
Draper, UT 84020-7177
Phone (801) 960-9355
Other practice location 2
1220 N Main St Ste 11
Springville, UT 84663-4016
Phone (801) 960-9355
Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2026. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.