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General NPI Number Information
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NPI Number | 1154300234
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Entity Type | Organization
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Legal Business Name | AXIS-ONE INC
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 5149 SOUTH 1500 WEST
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City | RIVERDALE
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State | UT
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Zip | 84405
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Country | US
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Telephone | 801-475-0402
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Fax | 801-475-7464
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Provider Business Mailing Address
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Address Line | 5149 SOUTH 1500 WEST
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City | RIVERDALE
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State | UT
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Zip | 84405
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Country | US
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Telephone | 801-475-0402
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Fax | 801-475-7464
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | MR. EMORY SINGLETARY
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Credential |
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Telephone | 801-475-0402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 47306713501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1418053501
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 50176303501
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License Number State | UT
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 49189582601
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License Number State | UT
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Taxonomy #6
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 2083338900
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License Number State | UT
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Taxonomy #7
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3231733501
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License Number State | UT
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