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NPI Code Detail

MEDICARE: PAUL THOMAS CALLISTER CMHC

MEDICARE: PAUL THOMAS CALLISTER CMHC
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
1101Y00000XCounselor76991046009UT

General Provider Information

NPI Number : 1518276716
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL THOMAS CALLISTER CMHC
Provider Business Mailing Address
First Line : PO BOX 4102
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84110
Country : US
Telephone Number : 801-755-5138
Fax Number :
Provider Business Practice Location Address
First Line : 275 E SOUTH TEMPLE STE 202
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-1273
Country : US
Telephone Number : 801-755-5138
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2010
Last Update Date : 06/08/2016

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Directions to “ PAUL THOMAS CALLISTER CMHC” Practice Location

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