Individual
BENJAMIN BERTHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
5770 S 1500 W, SALT LAKE CITY, UT 84123-5216
(801) 265-3412
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
14241564-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
14241564-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
286456
AZ
Other
Enumeration date
08/18/2020
Last updated
05/01/2026
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