Provider Demographics
NPI:1790595924
Name:DONNY AT WELLBRIDGE
Entity type:Organization
Organization Name:DONNY AT WELLBRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-609-4561
Mailing Address - Street 1:247 E 930 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5001
Mailing Address - Country:US
Mailing Address - Phone:801-609-4561
Mailing Address - Fax:801-797-0254
Practice Address - Street 1:247 E 930 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5001
Practice Address - Country:US
Practice Address - Phone:801-609-4561
Practice Address - Fax:801-797-0254
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLBRIDGE MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)