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DR. BRANDON J WILDE CMHC
NPI 1710140447
Counselor - Mental Health in Provo, UT

Active since July 02, 2008PECOS Enrolled
122 E 1700 S BLDG 3, PROVO, UT 84606(801) 900-3656 Get Directions Write a Review

NPPES record last updated: September 10, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Brandon J Wilde Cmhc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BRANDON J WILDE CMHC (NPI 1710140447) is an individual mental health provider in Provo, Utah, licensed in Utah (9471022-6044) and active in the NPI registry since July 2008. He is enrolled in Medicare PECOS and maintains a secondary practice location in Chubbuck.

NPPES Registry Identity

NPI1710140447
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameDR. BRANDON J WILDECredential: CMHC
Location Address122 E 1700 S BLDG 3Provo, UT 84606-5644
Mailing Address7897 N Broken Arrow LnEagle Mountain, UT 84005-7203 · (602) 460-6428
Phone(801) 900-3656
Sole ProprietorYes
Enumeration DateJuly 2, 2008
Last NPPES UpdateSeptember 10, 2024
NPPES CertifiedSeptember 10, 2024
✔ NPI 1710140447 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
Licenses✔ Licensed in UT · 9471022-6044✔ Licensed in UT · 9471002-6004✔ Licensed in ID · LPC3887✔ Licensed in AZ · LPC-17502
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License CP3313-R (NV)
122 E 1700 S BLDG 3, Provo, UT 84606
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Secondary Practice Location 1

Location 14460 Central Way, SUITE 2Chubbuck, ID 83202 · Phone (208) 237-1711 · Fax (208) 237-5192

Other Identifiers 2

Medicaid807197600ID
Medicaid4290476UT

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona, BridgeSpan Health Company, Regence BlueCross BlueShield of Utah and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Brandon J Wilde Cmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROCKY MOUNTAIN UNIVERSITY OF HEALTH PROFESSIONS FOUNDATION
Physical Therapist
122 E 1700 S BLDG 3
PROVO, UT 84606
Utah County (801) 915-5281
KATHLEEN DAO GARLICK
Student in an Organized Health Care Education/Training Program
122 E 1700 S BLDG 3
PROVO, UT 84606
Utah County (801) 375-5125
MR. ADAM L HICKENBOTHAM OD
Optometrist
122 E 1700 S BLDG 3
PROVO, UT 84606
Utah County (385) 248-5550
KASEY BUTLER
Speech-Language Pathologist
122 E 1700 S BLDG 3
PROVO, UT 84606
Utah County (385) 248-5601
ANGELICA A ECHIVERRI OD
Optometrist
122 E 1700 S BLDG 3
PROVO, UT 84606
Utah County (385) 248-5550
NATALIE MAE STAPP
Physician Assistant
122 E 1700 S BLDG 3
PROVO, UT 84606
Utah County (801) 472-3902
NAOMI ROMANO
Case Manager/Care Coordinator
122 E 1700 S BLDG 3
PROVO, UT 84606
Utah County (385) 715-0748
WILLIAM REID CLUFF OD
Optometrist (Corneal and Contact Management)
122 E 1700 S BLDG 3
PROVO, UT 84606
Utah County (385) 248-5550

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brandon Wilde's NPI number?

The NPI number for Brandon Wilde is 1710140447. It was assigned to this individual provider in the NPPES registry on July 2, 2008.

Where is Brandon Wilde located?

Brandon Wilde practices at 122 E 1700 S Bldg 3, Provo, UT 84606. The listed phone number is (801) 900-3656.

What is Brandon Wilde's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Brandon Wilde enrolled in Medicare?

Yes. Brandon Wilde is registered in the Medicare PECOS enrollment system.

What insurance does Brandon Wilde accept?

Health plans from Blue Cross Blue Shield of Arizona, BridgeSpan Health Company, Regence BlueCross BlueShield of Utah, Select Health and UnitedHealthcare list Brandon Wilde as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Brandon Wilde was last updated on September 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.