1720756968 NPI number — INTEGRATED HEALTH COUNSELING, LLC

Table of content: DR. IAN RICHARD MCKENZIE DO (NPI 1326541137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720756968 NPI number — INTEGRATED HEALTH COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTH COUNSELING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1720756968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2616 S 1900 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLC
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84106-4156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-200-3129
Provider Business Mailing Address Fax Number:
801-928-7698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4516 S 700 E STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-4192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-200-3129
Provider Business Practice Location Address Fax Number:
801-928-7698
Provider Enumeration Date:
09/02/2021

Additional Information

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
REX
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
801-200-3129

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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