Caleb Clark
Individual provider Active NPI Counselor · Riverdale, UT
NPI 1861934812 · NPPES record last updated Nov 8, 2016
Key facts
- NPI
- 1861934812
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 5202 Freeway Park Dr
Riverdale, UT 84405-4016 - Phone
- (801) 255-5131
- NPI assigned
- Nov 8, 2016
- 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
5202 Freeway Park Dr
Riverdale, UT 84405-4016
Mailing address
6013 S Redwood Rd
Taylorsville, UT 84123-5220
Phone (801) 255-5131
Other providers in Riverdale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2016. 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.