Blaine Larsen
Individual provider Active NPI Counselor · Moroni, UT
NPI 1447546353 · NPPES record last updated Jun 20, 2011
Key facts
- NPI
- 1447546353
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 21260 N 1450 E
Moroni, UT 84646-0461 - Phone
- (435) 445-5200
- Fax
- (435) 445-5201
- NPI assigned
- Jun 20, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | UT | Yes |
Addresses
Primary practice location
21260 N 1450 E
Moroni, UT 84646-0461
Mailing address
PO Box 461
21260 N 1450 E
Moroni, UT 84646-0461
Phone (435) 445-5200
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 Jun 20, 2011. 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.