Dan Rickenbach
Individual provider Active NPI Counselor · Moroni, UT
NPI 1174060040 · NPPES record last updated Jan 30, 2017
Key facts
- NPI
- 1174060040
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 21260 N 1450 E
Moroni, UT 84646-0461 - Phone
- (435) 445-3630
- Fax
- (435) 445-3633
- NPI assigned
- Jan 30, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lighthouse Ranch Corporation | Past | Accepting new patients | |
| Blue Hills Residential Treatment | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
21260 N 1450 E
Moroni, UT 84646-0461
Mailing address
PO Box 461
Moroni, UT 84646
Phone (435) 445-5200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235458555 | Medicaid | UT |
Other providers in Moroni, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2017. 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.