Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Great Salt Lake Wellness Inc

Organization Clinical Psychologist · NPI 1790152940

Great Salt Lake Wellness Inc is a Clinical Psychologist in Kaysville, Utah. Licensed in Utah. Registered with an NPI since 2015.

Licensed in
UT
In the registry since
2015
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

375 N Main St Ste 202
Kaysville, UT 84037-1278
Phone: (801) 844-1615
Fax: (801) 825-1162
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 7510289-2501 (UT)

Record details

NPI number1790152940
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Emily Bullock — Owner · (801) 389-9521
NPI enumeratedAugust 24, 2015
Last updated in NPPESApril 17, 2024
Certification dateApril 17, 2024
Mailing address375 N Main St Ste 202, Kaysville, UT 84037-1278

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