MEDICARE: AXIS-ONE INC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	47306713501	UT
2	101YM0800X	Mental Health Counselor	1418053501	UT
3	101YM0800X	Mental Health Counselor
4	101YM0800X	Mental Health Counselor	50176303501	UT
5	103T00000X	Psychologist	49189582601	UT
6	163WP0808X	Psychiatric/Mental Health Registered Nurse	2083338900	UT
7	101YM0800X	Mental Health Counselor	3231733501	UT

General Provider Information

NPI Number	:	1154300234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIS-ONE INC

Provider Business Mailing Address
First Line	:	5149 SOUTH 1500 WEST
Second Line	:
City	:	RIVERDALE
State	:	UT
Zip	:	84405
Country	:	US
Telephone Number	:	801-475-0402
Fax Number	:	801-475-7464

Provider Business Practice Location Address
First Line	:	5149 SOUTH 1500 WEST
Second Line	:
City	:	RIVERDALE
State	:	UT
Zip	:	84405
Country	:	US
Telephone Number	:	801-475-0402
Fax Number	:	801-475-7464

Authorized Official
Title or Position	:	EXECUTIVE ADMINISTRATOR
Name	:	MR. EMORY SINGLETARY
Credential	:
Telephone Number	:	801-475-0402

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	05/22/2008

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Directions to “AXIS-ONE INC ” Practice Location

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