Richard Wayne Mickelsen, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

5336032-1205 Issued in UT

Practice address

1300 E Center St
Provo, UT 84606-3554

Phone

(801) 344-4215

Fax

(801) 344-4225

NPI assigned

Jan 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Lumos Psychiatric Services LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Bluffdale, UT
  • NPI 1548141385
  NPD
• Lumos Enterprises LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Bluffdale, UT
  • NPI 1881313187

  Child & Adolescent Psychiatry

  NPD (past)
• Valley Behavioral Health Incorporated

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • West Valley City, UT
  • NPI 1932166980

  Psychiatry

  NPD (past)
• Youth Care of Utah, Inc.

  • Psychiatric Residential Treatment Facility
  • Draper, UT
  • NPI 1083767297
  NPD (past)

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771372800000",
    "number": "1740250372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 E CENTER ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846063554",
            "telephone_number": "801-344-4400",
            "fax_number": "801-344-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E CENTER ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846063554",
            "telephone_number": "801-344-4215",
            "fax_number": "801-344-4225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14241 S Redwood Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Bluffdale",
            "state": "UT",
            "postal_code": "840655216",
            "country_code": "US",
            "telephone_number": "385-342-2808",
            "fax_number": "385-220-2658",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "327 W Gordon Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Layton",
            "state": "UT",
            "postal_code": "840412381",
            "country_code": "US",
            "telephone_number": "385-342-2808",
            "fax_number": "385-220-2658",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12595 S Minuteman Dr",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840209541",
            "country_code": "US",
            "telephone_number": "801-572-6989",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14241 S Redwood Rd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Bluffdale",
            "state": "UT",
            "postal_code": "840655223",
            "country_code": "US",
            "telephone_number": "801-915-6007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKELSEN",
        "first_name": "RICHARD",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2026-02-18",
        "certification_date": "2026-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "5336032-1205",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "UT",
            "license": "5336032-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESERET MUTUAL",
            "identifier": "U002",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATORS MUTUAL",
            "identifier": "U003",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "U001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERMOUTAIN HEALTH CARE",
            "identifier": "U006",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "U009",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rhonda L Metcalf, PT
• Julia G. Meyer, M.D.
• Melissa Sue Meyer, LCSW
• Itzel Alejandra Meza Madeira
• Abby Grace Michalak
• Sue Gail Middleton, PHD, LCSW
• Alicia Milberger
• Elizabeth Miles
• Leslie Wilden Miles, APRN
• Rachel Miles

• Child & Adolescent Psychiatry Physician in Provo, UT
• Providers in Provo, UT by specialty
• Child & Adolescent Psychiatry Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 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.