John Raynor
Individual provider Active NPI Counselor · Mona, UT
NPI 1093051971 · NPPES record last updated Dec 20, 2012
Key facts
- NPI
- 1093051971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 525 W 200 N
Mona, UT 84648 - Phone
- (801) 375-4240
- Fax
- (801) 375-4241
- NPI assigned
- Dec 20, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
525 W 200 N
Mona, UT 84648
Mailing address
619 N 500 W
Provo, UT 84601-1547
Phone (801) 375-4240
Other providers in Mona, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.