| Numinus Wellness Utah Inc | |
|
672 W 400 S Ste 201 Springville UT 84663-3170 | |
| (801) 369-8989 | |
| (801) 704-9741 |
| Full Name | Numinus Wellness Utah Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 672 W 400 S Ste 201, Springville, Utah |
| Authorized Official Name and Position | Reid Justin Robison (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 8013698989 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Numinus Wellness Utah Inc 672 W 400 S Ste 201 Springville UT 84663-3170 Ph: (801) 369-8989 | Numinus Wellness Utah Inc 672 W 400 S Ste 201 Springville UT 84663-3170 Ph: (801) 369-8989 |
| NPI Number | 1265092282 |
|---|---|
| Provider Enumeration Date | 06/20/2019 |
| Last Update Date | 01/23/2024 |
| Certification Date | 01/23/2024 |
| Medicare PECOS PAC ID | 2163750688 |
|---|---|
| Medicare Enrollment ID | O20190822000230 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265092282 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | James M Marcum |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013938588 PECOS PAC ID: 7517850183 Enrollment ID: I20040206000183 |
| Provider Name | Brett W Sharp |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750301529 PECOS PAC ID: 3072582303 Enrollment ID: I20041001000958 |
| Provider Name | Reid J Robison |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760539415 PECOS PAC ID: 1456403781 Enrollment ID: I20090717000480 |
| Provider Name | Reynie T Sandoval |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295041614 PECOS PAC ID: 7810110426 Enrollment ID: I20140529002192 |
| Provider Name | Lorrie M Belnap |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093006348 PECOS PAC ID: 8820306228 Enrollment ID: I20151005002664 |
| Provider Name | Shadrick W Tillotson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528514809 PECOS PAC ID: 6709168073 Enrollment ID: I20170120001879 |
| Provider Name | Gary Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063962140 PECOS PAC ID: 7214209501 Enrollment ID: I20170822000592 |
| Provider Name | Nicholas Alan Baston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740739366 PECOS PAC ID: 7214215276 Enrollment ID: I20180327000508 |
| Provider Name | Robyn Michele Tate |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881029957 PECOS PAC ID: 2860744711 Enrollment ID: I20181004001155 |
| Provider Name | Nathaniel M Barusch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548648520 PECOS PAC ID: 3375879653 Enrollment ID: I20190724001587 |
| Provider Name | Landon Robert Moyers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811554751 PECOS PAC ID: 9032445978 Enrollment ID: I20190730002323 |
| Provider Name | Joshua Reed Bentley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447805809 PECOS PAC ID: 2062743065 Enrollment ID: I20191004002344 |
| Provider Name | Karl Jo Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932693587 PECOS PAC ID: 8022431816 Enrollment ID: I20200713002055 |
| Provider Name | Tessa Jane Hamilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104459767 PECOS PAC ID: 3072936756 Enrollment ID: I20200714001838 |
| Provider Name | Stephen Donald Thayer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881996148 PECOS PAC ID: 9537434162 Enrollment ID: I20200714003667 |
| Provider Name | Robert G Mcnutt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447817226 PECOS PAC ID: 9830514652 Enrollment ID: I20200810003302 |
| Provider Name | Hannah Raquel Cross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457703761 PECOS PAC ID: 7113344649 Enrollment ID: I20200829000191 |
| Provider Name | Susanna Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669919767 PECOS PAC ID: 2567732472 Enrollment ID: I20201231001634 |
| Provider Name | Siqin Luo Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578128443 PECOS PAC ID: 3870908213 Enrollment ID: I20210217003047 |
| Provider Name | Elizabeth Baker Mccoy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174134860 PECOS PAC ID: 7618382581 Enrollment ID: I20210226002590 |
| Provider Name | Amanda Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245755800 PECOS PAC ID: 3678989506 Enrollment ID: I20210301002222 |
| Provider Name | Paul Douglas Thielking |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124036595 PECOS PAC ID: 7416848007 Enrollment ID: I20210428002407 |
| Provider Name | Colin Andrew Riley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497324370 PECOS PAC ID: 4385046028 Enrollment ID: I20210716002024 |
| Provider Name | Ronda Ann Merrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881829117 PECOS PAC ID: 3274937883 Enrollment ID: I20210804001414 |
| Provider Name | Scott Salomone |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386178481 PECOS PAC ID: 9931454253 Enrollment ID: I20210818000456 |
| Provider Name | Deven Richard Jennings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699357913 PECOS PAC ID: 8224434774 Enrollment ID: I20210908002162 |
| Provider Name | Michael Ah You |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396412698 PECOS PAC ID: 1456758028 Enrollment ID: I20210923003006 |
| Provider Name | Uva Gottlieb Most |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427299932 PECOS PAC ID: 8426448523 Enrollment ID: I20211203001947 |
| Provider Name | Gholson James Lyon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811910508 PECOS PAC ID: 9638473416 Enrollment ID: I20211216000391 |
| Provider Name | Jacob Michael Oaklyn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275139339 PECOS PAC ID: 6709278575 Enrollment ID: I20220128001014 |
| Provider Name | Katherine Mckell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225798416 PECOS PAC ID: 6305230806 Enrollment ID: I20220227000045 |
| Provider Name | Christopher Sorensen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912228230 PECOS PAC ID: 4587980784 Enrollment ID: I20220307001599 |
| Provider Name | Maurice Fiedel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265035257 PECOS PAC ID: 8022343763 Enrollment ID: I20220308000696 |
| Provider Name | Courtney Claire Marden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265000756 PECOS PAC ID: 7214321280 Enrollment ID: I20220309002101 |
| Provider Name | Jacqueline Briggs Allred |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124348453 PECOS PAC ID: 9931595691 Enrollment ID: I20220405002106 |
| Provider Name | Margaret E Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073698692 PECOS PAC ID: 3971784877 Enrollment ID: I20220422000576 |
| Provider Name | Ruby S Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962070615 PECOS PAC ID: 2769879600 Enrollment ID: I20220425001171 |
| Provider Name | Scott Osabuohien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376281477 PECOS PAC ID: 6305225715 Enrollment ID: I20220615001102 |
| Provider Name | Raymond Antonio Archuleta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366173171 PECOS PAC ID: 1759760333 Enrollment ID: I20220628002803 |
| Provider Name | Hannah Lindsey Banks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851021604 PECOS PAC ID: 7810378114 Enrollment ID: I20220718003221 |
| Provider Name | Angeleah Marie Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720719073 PECOS PAC ID: 2264814086 Enrollment ID: I20220726003122 |
| Provider Name | Sherrie Irvine Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932773678 PECOS PAC ID: 8224404926 Enrollment ID: I20221020003113 |
| Provider Name | Lindsey Paige Gavin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487373007 PECOS PAC ID: 6103293519 Enrollment ID: I20221027001716 |
| Provider Name | Jody M Newman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467100461 PECOS PAC ID: 5991175374 Enrollment ID: I20221229000316 |
| Provider Name | Sevon Taroian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023562667 PECOS PAC ID: 5890166813 Enrollment ID: I20230130000564 |
| Provider Name | Cheri Mills |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174905988 PECOS PAC ID: 4385018233 Enrollment ID: I20230316001718 |
| Provider Name | Danielle Musick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174221089 PECOS PAC ID: 3476927104 Enrollment ID: I20230321001565 |
| Provider Name | Jaden Michael Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407533185 PECOS PAC ID: 9436511334 Enrollment ID: I20230809001565 |
| Provider Name | Michael Wesley Sherman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992081228 PECOS PAC ID: 5890158125 Enrollment ID: I20230901003136 |
| Provider Name | Carlos Alberto Palomo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457701203 PECOS PAC ID: 2860846102 Enrollment ID: I20230920003757 |
| Provider Name | John Ellis |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1750637393 PECOS PAC ID: 9638582430 Enrollment ID: I20240103002849 |
| Provider Name | Tammy Lynn Dunn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558851782 PECOS PAC ID: 8628420015 Enrollment ID: I20240122002898 |
| Provider Name | Heather L Brady |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1508510173 PECOS PAC ID: 0547605388 Enrollment ID: I20240301003364 |
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