MEDICARE: SPENCER KOHLER ACMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6388761-6009	UT

General Provider Information

NPI Number	:	1003554296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER KOHLER ACMHC

Provider Business Mailing Address
First Line	:	PO BOX 1536
Second Line	:
City	:	PAROWAN
State	:	UT
Zip	:	84761-1536
Country	:	US
Telephone Number	:	435-393-5122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2069 N MAIN ST STE 101
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-5602
Country	:	US
Telephone Number	:	435-267-4212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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