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NPI Code Detail

MEDICARE: BRIAN C CARL PHD PLLC

MEDICARE: BRIAN C CARL PHD PLLC
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
1261QM0850XAdult Mental Health Clinic/Center6900557-2501UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16900557-2501OTHERUTUT STATE LICENSE

General Provider Information

NPI Number : 1730555129
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIAN C CARL PHD PLLC
Provider Business Mailing Address
First Line : 223 S 700 E
Second Line : #1
City : SALT LAKE CITY
State : UT
Zip : 84102-2171
Country : US
Telephone Number : 801-839-5594
Fax Number :
Provider Business Practice Location Address
First Line : 223 S 700 E
Second Line : #1
City : SALT LAKE CITY
State : UT
Zip : 84102-2171
Country : US
Telephone Number : 801-839-5594
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. BRIAN C CARL
Credential : PHD
Telephone Number : 801-839-5594
Provider Enumeration Date : 08/19/2015
Last Update Date : 08/19/2015

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