Healthcare Provider Details

I. General information

NPI: 1396236535
Provider Name (Legal Business Name): VANCE MCARTHUR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 W BEARCAT DR
SALT LAKE CITY UT
84115-2519
US

IV. Provider business mailing address

447 W BEARCAT DR
SALT LAKE CITY UT
84115-2519
US

V. Phone/Fax

Practice location:
  • Phone: 385-888-1028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: