MEDICARE: AMBERLY POWERS

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	8255859-6009	UT

General Provider Information

NPI Number	:	1962094177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBERLY POWERS

Provider Business Mailing Address
First Line	:	209 E GORDON AVE
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-2341
Country	:	US
Telephone Number	:	801-549-8821
Fax Number	:

Provider Business Practice Location Address
First Line	:	1438 N HIGHWAY 89 STE 1
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-2944
Country	:	US
Telephone Number	:	801-549-8821
Fax Number	:

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

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	09/21/2021

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Directions to “ AMBERLY POWERS ” Practice Location

Language	Start Address	Practice Location

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