MEDICARE: KELCI WARD BEUS

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	10822128-6009	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10822128-6009	OTHER	UT	STATE OF UTAH DEPARTMENT OF COMMERCE DIVISION OF OCCUPATIONAL & PROFESSIONAL LIC

General Provider Information

NPI Number	:	1598294183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELCI WARD BEUS

Provider Business Mailing Address
First Line	:	2727 N WASHINGTON BLVD STE 301
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-2276
Country	:	US
Telephone Number	:	801-710-0421
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 N WASHINGTON BLVD STE 301
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-2276
Country	:	US
Telephone Number	:	801-710-0421
Fax Number	:

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

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	05/03/2019

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Directions to “ KELCI WARD BEUS ” Practice Location

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