MEDICARE: DR. BRIGG BROMLEY NOYES PHD

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	103TC1900X	Counseling Psychologist	5334408-2501	UT

General Provider Information

NPI Number	:	1083842488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIGG BROMLEY NOYES PHD

Provider Business Mailing Address
First Line	:	77 S 700 E
Second Line	:	SUITE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1138
Country	:	US
Telephone Number	:	801-363-0306
Fax Number	:	801-483-3010

Provider Business Practice Location Address
First Line	:	77 S 700 E
Second Line	:	SUITE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1138
Country	:	US
Telephone Number	:	801-363-0306
Fax Number	:	801-483-3010

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

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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