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NPI Code Detail

MEDICARE: MR. RONALD ELLIS POWELL

MEDICARE: MR. RONALD ELLIS POWELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor6220020-3503UT
2101YA0400XAddiction (Substance Use Disorder) Counselor111182-6006UT

General Provider Information

NPI Number : 1184869182
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD ELLIS POWELL
Provider Business Mailing Address
First Line : 5965 S 900 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-1720
Country : US
Telephone Number : 801-263-7100
Fax Number :
Provider Business Practice Location Address
First Line : 344 E 100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-1700
Country : US
Telephone Number : 800-322-3222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2008
Last Update Date : 09/13/2018

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