1346806403 NPI number — JULIA CARROLL MOENCH-PARENT ACMHC

Table of content: JULIA CARROLL MOENCH-PARENT ACMHC (NPI 1346806403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346806403 NPI number — JULIA CARROLL MOENCH-PARENT ACMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOENCH-PARENT
Provider First Name:
JULIA
Provider Middle Name:
CARROLL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACMHC
Provider Gender Code:
F

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:
1346806403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7628 S RIVERWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTONWOOD HEIGHTS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84093-6134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-750-1533
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8375 S 700 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84070-0504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-981-8702
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2019

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: 101YM0800X , with the licence number:  10444864-6009 , 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)





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