GREAT SALT LAKE WELLNESS INC
NPI 1790152940
Psychologist - Clinical in Kaysville, UT

Q: What is Great Salt Lake Wellness Inc's NPI number?

The NPI number for Great Salt Lake Wellness Inc is 1790152940. It was assigned to this organization in the NPPES registry on August 24, 2015.

Q: What is Great Salt Lake Wellness Inc's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since August 24, 2015

375 N MAIN ST STE 202, KAYSVILLE, UT 84037(801) 844-1615(801) 825-1162 Get Directions Write a Review

NPPES record last updated: April 17, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Great Salt Lake Wellness Inc NPPES

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

GREAT SALT LAKE WELLNESS INC (NPI 1790152940) is a healthcare organization registered as a clinical in Kaysville, Utah and active in the NPI registry since August 2015. The organization lists Emily Young Bullock, Owner, as its authorized official.

NPPES Registry Identity

NPI1790152940

Entity TypeOrganization

Primary Taxonomy103TC0700X

Legal Business NameGREAT SALT LAKE WELLNESS INC

Location Address375 N MAIN ST STE 202Kaysville, UT 84037-1278

Mailing Address375 N Main St Ste 202Kaysville, UT 84037-1278 · (801) 844-1615 · Fax (385) 209-2975

Phone(801) 844-1615

Fax(801) 825-1162

Organization SubpartNo

Authorized OfficialEmily Young BullockOwner · (801) 389-9521

Enumeration DateAugust 24, 2015

Last NPPES UpdateApril 17, 2024

NPPES CertifiedApril 17, 2024

✔ NPI 1790152940 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in UT · 7510289-2501

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

375 N MAIN ST STE 202, Kaysville, UT 84037

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Great Salt Lake Wellness Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 6 clinicians reassign Medicare billing to Great Salt Lake Wellness Inc, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Trevor James

Mental Health Counselor

NPI 1396413167

375 N MAIN ST STE 202
Kaysville, UT 84037

(801) 844-1615

✔ PECOS✔ Accepts MedicareSame address

Brittany Shields

Clinical Social Worker

NPI 1952087124

375 N MAIN ST STE 202
Kaysville, UT 84037

(801) 844-1615

✔ PECOS✔ Accepts MedicareSame address

Kirt Cundick, PH.D.

Clinical Psychologist

NPI 1629395181

1454 N HILL FIELD RD STE 3
Layton, UT 84041

(801) 784-6894

✔ PECOS✔ Accepts Medicare3.2 mi

Emily Bullock, PSY.D.

Clinical Psychologist

NPI 1760670962

240 N EAST PROMONTORY STE 200
Farmington, UT 84025

(801) 844-1615

✔ PECOS✔ Accepts Medicare4.4 mi

Carrie Moore, LMHC

Mental Health Counselor

NPI 1356893804

2635 E BARNWOOD LN
Heber City, UT 84032

(561) 573-4848

✔ PECOS✔ Accepts Medicare48 mi

Tifany Barlow, LCSW

Clinical Social Worker

NPI 1902233950

230 N 1680 E STE 2
St George, UT 84790

(801) 906-1736

✔ PECOS✔ Accepts Medicare284 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Great Salt Lake Wellness Inc's NPI number?

The NPI number for Great Salt Lake Wellness Inc is 1790152940. It was assigned to this organization in the NPPES registry on August 24, 2015.

Where is Great Salt Lake Wellness Inc located?

Great Salt Lake Wellness Inc is located at 375 N Main St Ste 202, Kaysville, UT 84037. The listed phone number is (801) 844-1615.

What is Great Salt Lake Wellness Inc's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Great Salt Lake Wellness Inc enrolled in Medicare?

Yes. Great Salt Lake Wellness Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Great Salt Lake Wellness Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians reassign their Medicare billing to Great Salt Lake Wellness Inc, in Clinical Psychologist, Clinical Social Worker and Mental Health Counselor. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Great Salt Lake Wellness Inc accept?

Health plans from BridgeSpan Health Company, Molina Healthcare and Regence BlueCross BlueShield of Utah list Great Salt Lake Wellness Inc 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 Great Salt Lake Wellness Inc was last updated on April 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.