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NPI Code Detail

MEDICARE: MR. DANIEL POULSON

MEDICARE: MR. DANIEL POULSON
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16337850OTHERUTAMERICAN COUNSELING ASSOCIATION

General Provider Information

NPI Number : 1639441694
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DANIEL POULSON
Provider Business Mailing Address
First Line : 2015 CRYSTAL AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-1704
Country : US
Telephone Number : 801-631-8147
Fax Number :
Provider Business Practice Location Address
First Line : 32 W WINCHESTER ST
Second Line : SUITE 101
City : SALT LAKE CITY
State : UT
Zip : 84107-5607
Country : US
Telephone Number : 801-263-6367
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2012
Last Update Date : 02/06/2012

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