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NPI Code Detail

MEDICARE: ADAM NISENSON

MEDICARE: ADAM NISENSON
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
1103TC1900XCounseling Psychologist10312526-3904UT

General Provider Information

NPI Number : 1154984839
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADAM NISENSON
Provider Business Mailing Address
First Line : 2521 S PARK ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1307
Country : US
Telephone Number : 713-256-8033
Fax Number :
Provider Business Practice Location Address
First Line : 4505 S WASATCH BLVD STE 290
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-4204
Country : US
Telephone Number : 385-695-5949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2019
Last Update Date : 04/17/2019

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