Healthcare Provider Details

I. General information

NPI: 1851784839
Provider Name (Legal Business Name): PETER ALLEN SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALLEN SMITH

II. Dates (important events)

Enumeration Date: 03/14/2015
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 S 500 E STE 170
CLEARFIELD UT
84015-4027
US

IV. Provider business mailing address

2240 N HWY 89 SUITE C
HARRISVILLE UT
84404-2675
US

V. Phone/Fax

Practice location:
  • Phone: 801-603-2547
  • Fax:
Mailing address:
  • Phone: 801-393-6232
  • Fax: 801-393-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: