MEDICARE: INTEGRATED HEALTH COUNSELING, LLC

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

General Provider Information

NPI Number	:	1720756968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED HEALTH COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2616 S 1900 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84106-4156
Country	:	US
Telephone Number	:	801-200-3129
Fax Number	:	801-928-7698

Provider Business Practice Location Address
First Line	:	4516 S 700 E STE 120
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-4192
Country	:	US
Telephone Number	:	801-200-3129
Fax Number	:	801-928-7698

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. REX WHEELER
Credential	:
Telephone Number	:	801-200-3129

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	09/02/2021

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