| Mountainstar Behavioral Health Llc | |
|
630 Medical Dr Bountiful UT 84010-4908 | |
| (801) 299-2186 | |
| (801) 299-2416 |
| Full Name | Mountainstar Behavioral Health Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 630 Medical Dr, Bountiful, Utah |
| Authorized Official Name and Position | Louis Joseph (VP) |
| Authorized Official Contact | 6153737630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountainstar Behavioral Health Llc 2000 Health Park Dr Brentwood TN 37027-4525 Ph: (615) 373-7406 | Mountainstar Behavioral Health Llc 630 Medical Dr Bountiful UT 84010-4908 Ph: (801) 299-2186 |
| NPI Number | 1174868525 |
|---|---|
| Provider Enumeration Date | 12/11/2012 |
| Last Update Date | 08/29/2023 |
| Certification Date | 08/29/2023 |
| Medicare PECOS PAC ID | 1052558186 |
|---|---|
| Medicare Enrollment ID | O20130605000270 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174868525 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Michael Scott Roundy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255366696 PECOS PAC ID: 1355329046 Enrollment ID: I20040709000503 |
| Provider Name | Joe C Culbertson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548286792 PECOS PAC ID: 2961428552 Enrollment ID: I20051022000279 |
| Provider Name | Brian L Harlan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760579585 PECOS PAC ID: 4284656216 Enrollment ID: I20080318000547 |
| Provider Name | Matthew M Gaines |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275771453 PECOS PAC ID: 9436309267 Enrollment ID: I20130808000124 |
| Provider Name | Anthony M Petersen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336407790 PECOS PAC ID: 7214160761 Enrollment ID: I20160902001726 |
| Provider Name | Trent K Suggs |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346667235 PECOS PAC ID: 7214153048 Enrollment ID: I20181107003498 |
| Provider Name | Janice M Trump |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205308780 PECOS PAC ID: 4981945979 Enrollment ID: I20190329001990 |
| Provider Name | Jennifer Pemble Weakland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083859714 PECOS PAC ID: 9335324185 Enrollment ID: I20190506001797 |
| Provider Name | Zacharia Isaia Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881186385 PECOS PAC ID: 0648692947 Enrollment ID: I20200615001145 |
| Provider Name | Laura Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710593363 PECOS PAC ID: 9032518493 Enrollment ID: I20210604001545 |
| Provider Name | Austin Garrett Goebel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811421407 PECOS PAC ID: 0648522557 Enrollment ID: I20210611002441 |
| Provider Name | Allison Peet |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912433012 PECOS PAC ID: 5395090617 Enrollment ID: I20230130001020 |
| Provider Name | Jonathan Mark Fox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508583709 PECOS PAC ID: 6305218116 Enrollment ID: I20230203001755 |
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