MEDICARE: KARI ALTON LASC

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	53832766006	UT

General Provider Information

NPI Number	:	1376617530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI ALTON LASC

Provider Business Mailing Address
First Line	:	PO BOX 867
Second Line	:
City	:	PRICE
State	:	UT
Zip	:	84501
Country	:	US
Telephone Number	:	435-637-7200
Fax Number	:	435-637-2377

Provider Business Practice Location Address
First Line	:	45 EAST 100 SOUTH
Second Line	:
City	:	CASTLE DALE
State	:	UT
Zip	:	84513
Country	:	US
Telephone Number	:	435-381-2432
Fax Number	:	435-381-2542

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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