1114433364 NPI number — MR. TRACY LANE FUCHS CMHC, ASUDC

Table of content: MR. PETER P BERNHARDT M.A. (NPI 1730317298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114433364 NPI number — MR. TRACY LANE FUCHS CMHC, ASUDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUCHS
Provider First Name:
TRACY
Provider Middle Name:
LANE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CMHC, ASUDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114433364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54 W 1200 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84057-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-301-9703
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 S 200 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84042-2047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-784-9455
Provider Business Practice Location Address Fax Number:
888-876-2112
Provider Enumeration Date:
12/26/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  3083074-6008 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 3083074-6004 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3083074-6004 . This is a "DIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 3083074-6008 . This is a "DIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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