| Riverwoods Behavioral Health Pc | |
|
5314 River Run Dr Ste 350 Provo UT 84604-7708 | |
| (801) 787-9855 | |
| (801) 228-1756 |
| Full Name | Riverwoods Behavioral Health Pc |
|---|---|
| Speciality | Counselor |
| Location | 5314 River Run Dr Ste 350, Provo, Utah |
| Authorized Official Name and Position | Louise Hoyme (OFFICE BILLIING MANAGER) |
| Authorized Official Contact | 8013678076 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverwoods Behavioral Health Pc Po Box 970392 Orem UT 84097-0392 Ph: (801) 367-8076 | Riverwoods Behavioral Health Pc 5314 River Run Dr Ste 350 Provo UT 84604-7708 Ph: (801) 787-9855 |
| NPI Number | 1417488040 |
|---|---|
| Provider Enumeration Date | 03/24/2017 |
| Last Update Date | 03/11/2024 |
| Certification Date | 03/11/2024 |
| Medicare PECOS PAC ID | 4688194889 |
|---|---|
| Medicare Enrollment ID | O20250218003018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417488040 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Randal Scott Pennington |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801903786 PECOS PAC ID: 0345275582 Enrollment ID: I20050927001020 |
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