Emily Young Bullock, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

240 N East Promontory Ste 200
Farmington, UT 84025-2950

Phone

(801) 844-1615

Fax

(844) 221-4750

NPI assigned

Oct 12, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Great Salt Lake Wellness IncGroup PAC ID 4789985680, 6 clinicians

Numinus Wellness Ut IncGroup PAC ID 2163750688, 50 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Great Salt Lake Wellness Inc

  • Clinical Psychologist
  • Kaysville, UT
  • NPI 1790152940

  Clinical, UT

  Medicare reassignment Care Compare group NPD Authorized official
• Numinus Wellness Ut Inc

  • Psychiatry Physician
  • Springville, UT
  • NPI 1265092282

  UT

  Medicare reassignment Care Compare group NPD
• Ogden Internal Medicine & Urology LLC

  • Internal Medicine Physician
  • Ogden, UT
  • NPI 1003001553
  NPD (past)

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

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519171200000",
    "number": "1760670962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 N EAST PROMONTORY STE 200",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252950",
            "telephone_number": "801-844-1615",
            "fax_number": "844-221-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 N EAST PROMONTORY STE 200",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252950",
            "telephone_number": "801-844-1615",
            "fax_number": "844-221-4750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1477 N 2000 W Ste E",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "UT",
            "postal_code": "840159099",
            "country_code": "US",
            "telephone_number": "801-614-5866",
            "fax_number": "801-825-1162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "EMILY",
        "middle_name": "YOUNG",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-12",
        "last_updated": "2018-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PSYCHOLOGIST",
            "identifier": "7510289-2501",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Wilford Broadbent, MD
• Joshua Parker Brough
• Justin Tyler Brown, D.D.S
• Trenton Brown
• Carrie Lynn Bryant, PA-C
• Ashley Kayla Burton, PA-C
• Kimball Burton, DDS
• Brian Dibble Call, DDS
• Catherine Dodd Cardon, APRN, CPNP, DNP
• Care First, PLLC

• All providers in Farmington, UT
• Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.