Healthcare Provider Details

I. General information

NPI: 1992620769
Provider Name (Legal Business Name): ANOTHONY POOL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEJANDRA MILLSAP

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S MAIN ST
BRIGHAM CITY UT
84302-6719
US

IV. Provider business mailing address

60 S MAIN ST
BRIGHAM CITY UT
84302-6719
US

V. Phone/Fax

Practice location:
  • Phone: 435-239-8768
  • Fax: 435-921-5938
Mailing address:
  • Phone: 435-239-8768
  • Fax: 435-921-5938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1043994247
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: