MEDICARE: AGTECH4VETS

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	101Y00000X	Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1356026017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGTECH4VETS

Provider Business Mailing Address
First Line	:	1883 WEST ROYAL HUNTE DR STE 200A
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-4000
Country	:	US
Telephone Number	:	855-772-3374
Fax Number	:	855-483-2771

Provider Business Practice Location Address
First Line	:	1883 WEST ROYAL HUNTE DR STE 200A
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-4000
Country	:	US
Telephone Number	:	855-772-3374
Fax Number	:	855-483-2771

Authorized Official
Title or Position	:	MANAGER
Name	:	JACQUELINE IVERSON
Credential	:
Telephone Number	:	202-569-2990

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “AGTECH4VETS ” Practice Location

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