Healthcare Provider Details

I. General information

NPI: 1700842069
Provider Name (Legal Business Name): JAMES TODD NORTHROP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 S STATE ST
CLEARFIELD UT
84015-1061
US

IV. Provider business mailing address

189 S STATE ST
CLEARFIELD UT
84015-1061
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-2044
  • Fax:
Mailing address:
  • Phone: 801-773-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number273558-6004
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5436
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: