Healthcare Provider Details

I. General information

NPI: 1598245425
Provider Name (Legal Business Name): BLAKE TURNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 06/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 S 3270 W
WEST VALLEY CITY UT
84119-1119
US

IV. Provider business mailing address

1030 UNIVERSITY VLG
SALT LAKE CITY UT
84108-3452
US

V. Phone/Fax

Practice location:
  • Phone: 801-412-6920
  • Fax: 801-982-9232
Mailing address:
  • Phone: 435-232-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11256817-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: