Healthcare Provider Details

I. General information

NPI: 1912741083
Provider Name (Legal Business Name): KEVIN MARKL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 06/22/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5667 S REDWOOD RD # 6
TAYLORSVILLE UT
84123-5433
US

IV. Provider business mailing address

PO BOX 271102
SALT LAKE CITY UT
84127-1102
US

V. Phone/Fax

Practice location:
  • Phone: 385-425-3196
  • Fax:
Mailing address:
  • Phone: 385-495-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: