Organization
GREAT SALT LAKE WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY YOUNG BULLOCK PSYD (OWNER)
(801) 389-9521
Entity
Organization
Contact information
Practice address
375 N MAIN ST STE 202, KAYSVILLE, UT 84037-1278
(801) 844-1615
(801) 825-1162
Mailing address
375 N MAIN ST STE 202, KAYSVILLE, UT 84037-1278
(801) 844-1615
(385) 209-2975
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7510289-2501
UT
Other
Enumeration date
08/24/2015
Last updated
04/17/2024
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