| James L. Poulton, Ph.d., P.c., Inc. | |
|
850 E 300 S Suite 10 Salt Lake City UT 84102-2332 | |
| (801) 350-0117 | |
| (801) 350-3536 |
| Full Name | James L. Poulton, Ph.d., P.c., Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 850 E 300 S, Salt Lake City, Utah |
| Authorized Official Name and Position | James Lawrence Poulton (PRESIDENT) |
| Authorized Official Contact | 8013500117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| James L. Poulton, Ph.d., P.c., Inc. 850 E 300 S Suite 10 Salt Lake City UT 84102-2332 Ph: (801) 350-0117 | James L. Poulton, Ph.d., P.c., Inc. 850 E 300 S Suite 10 Salt Lake City UT 84102-2332 Ph: (801) 350-0117 |
| NPI Number | 1972644540 |
|---|---|
| Provider Enumeration Date | 02/08/2007 |
| Last Update Date | 12/17/2010 |
| Medicare PECOS PAC ID | 7113106840 |
|---|---|
| Medicare Enrollment ID | O20110126000771 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972644540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 114917-2501 (Utah) | Primary |
| Provider Name | James L Poulton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710028378 PECOS PAC ID: 7517954902 Enrollment ID: I20040428000289 |
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