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NPI Code Detail

MEDICARE: MR. ALEXANDER CARBON

MEDICARE: MR. ALEXANDER CARBON
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
1101YM0800XMental Health Counselor13689033-3502UT
21041C0700XClinical Social Worker13689033-3502UT

General Provider Information

NPI Number : 1144086208
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALEXANDER CARBON
Provider Business Mailing Address
First Line : 3510 TYLER AVE
Second Line :
City : OGDEN
State : UT
Zip : 84403-2164
Country : US
Telephone Number : 404-661-2895
Fax Number :
Provider Business Practice Location Address
First Line : 352 S DENVER ST STE 350
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-3059
Country : US
Telephone Number : 801-521-4227
Fax Number : 801-359-0777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2024
Last Update Date : 02/26/2024

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