Great Salt Lake Wellness Inc
NPI 1790152940ActiveOrganization· Psychologist, Clinical· Kaysville, UT
Psychologist, Clinical in Kaysville, Utah, registered in NPPES in August 2015. The authorized official on file is Emily Young Bullock, PSYD, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1790152940 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 24, 2015 |
| Last updated in NPPES | Apr 17, 2024 |
| Certified by provider | Apr 17, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | 7510289-2501 | UT |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (UT) |
|---|
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