Brandon J Wilde, CMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

9471022-6044 Issued in UT

Practice address

122 E 1700 S BLDG 3
Provo, UT 84606-5644

Phone

(801) 900-3656

NPI assigned

Jul 2, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1710140447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7897 N BROKEN ARROW LN",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "840057203",
            "telephone_number": "602-460-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E 1700 S BLDG 3",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846065644",
            "telephone_number": "801-900-3656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4460 Central Way",
            "address_2": "SUITE 2",
            "address_purpose": "LOCATION",
            "city": "Chubbuck",
            "state": "ID",
            "postal_code": "83202",
            "country_code": "US",
            "telephone_number": "208-237-1711",
            "fax_number": "208-237-5192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDE",
        "first_name": "BRANDON",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "CMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-02",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "9471002-6004",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LPC3887",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LPC-17502",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NV",
            "license": "CP3313-R",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "9471022-6044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807197600",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4290476",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Izabella Wignall
• Cameron David Wilbur
• Staci Wilcock, HSW
• Alicia A Wilcox
• Elizabeth Wilcox
• Camille Wilding
• Jeffrey Milton Wilding, ATC
• Noelle L Wilhelmsen, DDS
• Michael Wilkes
• Sandra Lee Wilkes, CSW

• Mental Health Counselor in Provo, UT
• Providers in Provo, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.