Bonneville Mental Health, PLLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

2903 Issued in UT

Legal business name

BONNEVILLE MENTAL HEALTH, PLLC

Practice address

134 W 1180 N Ste 4
Tooele, UT 84074-1483

Phone

(435) 228-4181

NPI assigned

Nov 20, 2013

Last updated

May 10, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nate Green

Title

Director of Operations

Phone

(435) 228-4181

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1902236458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 W 1180 N STE 4",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840741483",
            "telephone_number": "435-228-4181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 W 1180 N STE 4",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840741483",
            "telephone_number": "435-228-4181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNEVILLE MENTAL HEALTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-20",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "NATE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "435-228-4181"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "UT",
            "license": "2903",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "UT",
            "license": "2903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Rock Family Dental, PLLC
• Blue Willow Psychiatry
• Alyssa Bohn
• Amanda Bonacorso, BHCM
• Bonneville Mental Health
• Kimball Booth, OD
• Carol Bourne, BHCM
• Jessica E Bowen
• Randall Bown
• Anndrea M Boyer, P.A.

• Substance Use Disorder Rehabilitation Clinic/Center in Tooele, UT
• Providers in Tooele, UT by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; 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.