Active NPI
Mitchell R. Koles, PH.D.
- Psychologist
- Salt Lake City, UT
National Provider Identifier
1942365630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 116938-2501
- Practice address
- 505 E 200 S
Suite 303
Salt Lake City, UT 84102-2022 - Phone
- (801) 350-0121
- Fax
- (801) 350-9582
- NPI assigned
- Dec 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 116938-2501 | UT | Primary |
Addresses
Primary practice location
505 E 200 S
Suite 303
Salt Lake City, UT 84102-2022
Mailing address
505 E 200 S
Suite 303
Salt Lake City, UT 84102-2022
Phone (801) 350-0121
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2020 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116938-2501 | UT | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chris Wehl, PH.D., Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- Salt Lake City, UT
- NPI 1396867479
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1942365630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 E 200 S",
"address_2": "SUITE 303",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841022022",
"telephone_number": "801-350-0121",
"fax_number": "801-350-9582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 E 200 S",
"address_2": "SUITE 303",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841022022",
"telephone_number": "801-350-0121",
"fax_number": "801-350-9582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLES",
"first_name": "MITCHELL",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-25",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "UT",
"license": "116938-2501",
"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 Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.