Active NPI
Andria Koller
- Mental Health Counselor
- Salt Lake City, UT
National Provider Identifier
1245986991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 12544516-6010
- Practice address
- 2655 S Lake Erie Dr
Salt Lake City, UT 84120-7350 - Phone
- (919) 282-2967
- NPI assigned
- Feb 22, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 12544516-6010 | UT | Primary |
Addresses
Primary practice location
2655 S Lake Erie Dr
Salt Lake City, UT 84120-7350
Mailing address
701 E 2ND Ave Apt F
Salt Lake City, UT 84103-3681
Phone (919) 282-2967
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12544516-6010 | UT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645488000000",
"number": "1245986991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 E 2ND AVE APT F",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841033681",
"telephone_number": "919-282-2967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2655 S LAKE ERIE DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841207350",
"telephone_number": "919-282-2967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLLER",
"first_name": "ANDRIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-22",
"last_updated": "2022-02-22",
"certification_date": "2022-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "12544516-6010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.