MEDICARE: SAMUEL GEORGE STONE

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1720395668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL GEORGE STONE

Provider Business Mailing Address
First Line	:	4829 ODELL DR
Second Line	:
City	:	WEST VALLEY
State	:	UT
Zip	:	84120-2918
Country	:	US
Telephone Number	:	801-955-1799
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 ODELL DR
Second Line	:
City	:	WEST VALLEY
State	:	UT
Zip	:	84120-2918
Country	:	US
Telephone Number	:	801-955-1799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	09/13/2010

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Directions to “ SAMUEL GEORGE STONE ” Practice Location

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