MEDICARE: ANDREW TROTTER 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
1	101YM0800X	Mental Health Counselor	6245293-6004	UT

General Provider Information

NPI Number	:	1891181863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW TROTTER CMHC

Provider Business Mailing Address
First Line	:	2659 S 1500 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3534
Country	:	US
Telephone Number	:	801-673-0559
Fax Number	:	801-384-0557

Provider Business Practice Location Address
First Line	:	2670 S 2000 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1782
Country	:	US
Telephone Number	:	801-673-0559
Fax Number	:	801-384-0557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	04/07/2015

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