Daine Barlow, | |
3809 W 6200 S, Taylorsville, UT 84129-3725 | |
(888) 949-4864 | |
Not Available |
Full Name | Daine Barlow |
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Gender | Female |
Speciality | Counselor - Mental Health |
Location | 3809 W 6200 S, Taylorsville, Utah |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1629681572 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | MH19582 (Florida) | Secondary |
101YM0800X | Counselor - Mental Health | 14017207-6004 (Utah) | Primary |
Entity Name | Sondermind Provider Network Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1760854442 PECOS PAC ID: 9537572490 Enrollment ID: O20240620000157 |
Mailing Address | Practice Location Address |
---|---|
Daine Barlow, 3725 W 4100 S Ste 201, West Valley City, UT 84120-5411 Ph: () - | Daine Barlow, 3809 W 6200 S, Taylorsville, UT 84129-3725 Ph: (888) 949-4864 |
Jenessa Crowton, Counselor Medicare: Not Enrolled in Medicare Practice Location: 6013 S Redwood Rd, Taylorsville, UT 84123 Phone: 801-255-5131 | |
Jennifer Lutz, Counselor Medicare: Not Enrolled in Medicare Practice Location: 6013 S Redwood Rd, Taylorsville, UT 84123 Phone: 801-255-5131 Fax: 801-658-0604 | |
Valerie Hart, Counselor Medicare: Not Enrolled in Medicare Practice Location: 6013 S Redwood Rd, Taylorsville, UT 84123 Phone: 801-255-5131 Fax: 801-255-5131 | |
Cheyenne Nicholas, Counselor Medicare: Not Enrolled in Medicare Practice Location: 6013 S Redwood Rd, Taylorsville, UT 84123 Phone: 801-255-5131 | |
Catharine Jurek, Counselor Medicare: Not Enrolled in Medicare Practice Location: 6013 S Redwood Rd, Taylorsville, UT 84123 Phone: 801-255-5131 | |
Melissa Lamph, Counselor Medicare: Not Enrolled in Medicare Practice Location: 6013 S Redwood Rd, Taylorsville, UT 84123 Phone: 801-255-5131 Fax: 801-658-0604 | |
Joey Malula, Counselor Medicare: Not Enrolled in Medicare Practice Location: 6013 S Redwood Rd, Taylorsville, UT 84123 Phone: 801-255-5131 |