MEDICARE: INSIGHT COUNSELING CENTERS INC.

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	324500000X	Substance Abuse Rehabilitation Facility	4697	UT

General Provider Information

NPI Number	:	1770984403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSIGHT COUNSELING CENTERS INC.

Provider Business Mailing Address
First Line	:	2290 E 4500 S
Second Line	:	SUITE 230
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4492
Country	:	US
Telephone Number	:	801-561-4224
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 E 4500 S
Second Line	:	SUITE 230
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4492
Country	:	US
Telephone Number	:	801-561-4224
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAMUEL BRAUER
Credential	:
Telephone Number	:	801-561-4224

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	09/12/2014

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