Healthcare Provider Details

I. General information

NPI: 1174824692
Provider Name (Legal Business Name): TIMOTHY WAYNE KEFFER COUNSELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 N 350 W
LAYTON UT
84041-4829
US

IV. Provider business mailing address

1176 N 350 W
LAYTON UT
84041-4829
US

V. Phone/Fax

Practice location:
  • Phone: 801-808-5005
  • Fax: 801-225-7053
Mailing address:
  • Phone: 801-808-5005
  • Fax: 801-225-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: