Healthcare Provider Details

I. General information

NPI: 1740601095
Provider Name (Legal Business Name): CODY MERRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 S 550 E
OREM UT
84097-7793
US

IV. Provider business mailing address

619 N 500 W
PROVO UT
84601-1547
US

V. Phone/Fax

Practice location:
  • Phone: 385-449-0150
  • Fax:
Mailing address:
  • Phone: 801-375-4240
  • Fax: 801-375-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: