MEDICARE: PATRICK 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	106H00000X	Marriage & Family Therapist	12254209-3904	UT
2	106H00000X	Marriage & Family Therapist	12254209-3902	UT

General Provider Information

NPI Number	:	1992466049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK POWERS

Provider Business Mailing Address
First Line	:	4505 S WASATCH BLVD STE 290
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84124-4204
Country	:	US
Telephone Number	:	801-549-7695
Fax Number	:

Provider Business Practice Location Address
First Line	:	4505 S WASATCH BLVD STE 290
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84124-4204
Country	:	US
Telephone Number	:	801-549-7695
Fax Number	:

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

Provider Enumeration Date	:	12/31/2021
Last Update Date	:	11/15/2022

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Directions to “ PATRICK POWERS ” Practice Location

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