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NPI Code Detail

MEDICARE: ISRAEL PATTERSON

MEDICARE: ISRAEL PATTERSON
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 Counselor6492884-6009UT

General Provider Information

NPI Number : 1639550924
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISRAEL PATTERSON
Provider Business Mailing Address
First Line : 1258 W SOUTH JORDAN PKWY STE 202
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-4712
Country : US
Telephone Number : 801-255-1155
Fax Number : 801-255-0281
Provider Business Practice Location Address
First Line : 1258 W SOUTH JORDAN PKWY STE 202
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-4712
Country : US
Telephone Number : 801-255-1155
Fax Number : 801-255-0281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2015
Last Update Date : 06/12/2015

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