Wade Poulsen

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

7966792-6004 Issued in UT

Practice address

145 E 1300 S
Suite 501
Salt Lake City, UT 84115-5482

Phone

(385) 468-3559

Fax

(385) 468-3560

NPI assigned

Feb 24, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bear River Mental Health Services IncGroup PAC ID 0840102356, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bear River Mental Health Services Inc

  • Mental Health Counselor
  • Logan, UT
  • NPI 1285736553
  Medicare reassignment Care Compare group NPD
• Salt Lake County Criminal Justice Services

  • Clinical Social Worker
  • Salt Lake City, UT
  • NPI 1215374798
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1427355650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 E 1300 S",
            "address_2": "SUITE 501",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841155482",
            "telephone_number": "385-468-3559",
            "fax_number": "385-468-3560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 E 1300 S",
            "address_2": "SUITE 501",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841155482",
            "telephone_number": "385-468-3559",
            "fax_number": "385-468-3560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULSEN",
        "first_name": "WADE",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-24",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "7966792-6004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda A Potts, SLP
• Keith J Poulsen, D.D.S
• McKayla Poulsen, PHARMD
• McKenzie Poulsen
• Sarah Poulsen, CTRS
• Daniel Poulson
• Daniel Stanford Poulson, DDS
• Kimilyn Poulson
• Nathan A Poulson, MD
• Seth William Poulson

• Mental Health Counselor in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.