MEDICARE: CENTRAL UTAH COUNSELING CENTER

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	11188	UT

General Provider Information

NPI Number	:	1639185424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL UTAH COUNSELING CENTER

Provider Business Mailing Address
First Line	:	152 N 400 W
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-5549
Country	:	US
Telephone Number	:	435-283-8400
Fax Number	:	435-283-8401

Provider Business Practice Location Address
First Line	:	51 NORTH CENTER STREET
Second Line	:
City	:	DELTA
State	:	UT
Zip	:	84624
Country	:	US
Telephone Number	:	435-864-3073
Fax Number	:	435-864-3610

Authorized Official
Title or Position	:	CFO
Name	:	FARREL MARX
Credential	:
Telephone Number	:	435-283-8400

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	12/18/2017

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