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NPI Code Detail

MEDICARE: JANA CLAIRE FULMER MSC, CMHC

MEDICARE: JANA CLAIRE FULMER MSC, CMHC
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
1101YP2500XProfessional Counselor6053262-6009UT
2101YM0800XMental Health Counselor6053262-6004UT

General Provider Information

NPI Number : 1699077461
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANA CLAIRE FULMER MSC, CMHC
Provider Business Mailing Address
First Line : 200 PARKVIEW DR
Second Line :
City : PARK CITY
State : UT
Zip : 84098-5144
Country : US
Telephone Number : 801-355-2846
Fax Number : 801-359-3244
Provider Business Practice Location Address
First Line : 447 BEARCAT DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-2519
Country : US
Telephone Number : 801-355-2846
Fax Number : 801-359-3244
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2010
Last Update Date : 11/07/2014

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Directions to “ JANA CLAIRE FULMER MSC, CMHC” Practice Location

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