Provider Demographics
NPI:1124839808
Name:CENTERED BEHAVIORAL HEALTH AND WELLNESS
Entity type:Organization
Organization Name:CENTERED BEHAVIORAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/APRN
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:NICHOLAUS
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:801-867-5693
Mailing Address - Street 1:576 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2614
Mailing Address - Country:US
Mailing Address - Phone:801-867-5693
Mailing Address - Fax:
Practice Address - Street 1:576 CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2614
Practice Address - Country:US
Practice Address - Phone:801-867-5693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)