MEDICARE: DR. MICHAEL B HIMLE PH.D.

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	103TC0700X	Clinical Psychologist	7524525-2501	UT

General Provider Information

NPI Number	:	1548571094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL B HIMLE PH.D.

Provider Business Mailing Address
First Line	:	380 S 1530 E
Second Line	:	PSYCHOLOGY #502
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-0259
Country	:	US
Telephone Number	:	801-581-7529
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 S 1530 E
Second Line	:	502
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-0259
Country	:	US
Telephone Number	:	801-581-7529
Fax Number	:

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

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	05/31/2012

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