MEDICARE: MR. NOEL E. KOONS M.S., ACMHC

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	101YM0800X	Mental Health Counselor	8440518-6009	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	260022408	OTHER	UT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487091096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NOEL E. KOONS M.S., ACMHC

Provider Business Mailing Address
First Line	:	2363 N HILL FIELD RD
Second Line	:	SUITE #5
City	:	LAYTON
State	:	UT
Zip	:	84041-6909
Country	:	US
Telephone Number	:	801-525-4645
Fax Number	:

Provider Business Practice Location Address
First Line	:	2363 N HILL FIELD RD
Second Line	:	SUITE #5
City	:	LAYTON
State	:	UT
Zip	:	84041-6909
Country	:	US
Telephone Number	:	801-525-4645
Fax Number	:

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

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	10/28/2013

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